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Current Approach to Chronic Thromboembolic Disease Without Pulmonary Hypertension

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Pulmonary Hypertension

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Abstract

Symptomatic chronic thromboembolic disease (CTED) is a recently recognized clinical entity characterized by exertional dyspnea and functional limitation due to chronic thromboembolic occlusions of the pulmonary vasculature without resting pulmonary hypertension. To arrive at this diagnosis, an extensive and detailed evaluation is required, including high-quality imaging of the pulmonary vasculature, right heart catheterization, and cardiopulmonary exercise testing. Carefully selected patients might be treated with surgical or percutaneous procedures at expert centers. In this chapter, we describe current concepts on symptomatic CTED, a practical approach to diagnosis and management, and gaps in knowledge.

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Abbreviations

BPA:

Balloon pulmonary angioplasty

CO:

Cardiac output

CPET:

Cardiopulmonary exercise test

CTED:

Chronic thromboembolic disease

CTEPH:

Chronic thromboembolic pulmonary hypertension

CTPA:

CT pulmonary angiography

DSA:

Digital subtraction angiography

mPAP:

Mean pulmonary artery pressure

NYHA:

New York Heart Association

PCWP:

Pulmonary capillary wedge pressure

PE:

Pulmonary embolism

PEA:

Pulmonary endarterectomy

RHC:

Right heart catheterization

RV:

Right ventricle

TPR:

Total peripheral resistance

Vd/Vt:

Dead space fraction

Ve/VCO2:

Ventilatory equivalent for carbon dioxide

VO2:

Oxygen consumption

VQ scan:

Ventilation-perfusion scan

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Author information

Authors and Affiliations

  1. Department of Pulmonary, and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA

    Gustavo A. Heresi

  2. Internal Medicine Resident, Internal Medicine Department, Cleveland Clinic Akron General, Akron, OH, USA

    Batool Jamal AbuHalimeh

Authors
  1. Gustavo A. Heresi
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  2. Batool Jamal AbuHalimeh
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Correspondence to Gustavo A. Heresi .

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Editors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Department of Medicine Pulmonary Hypertension Program University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    H. James Ford

  2. Department of Pulmonary, and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA

    Gustavo A. Heresi

  3. Division of Pulmonary Allergy and Critical Care Medicine, Pittsburgh Heart, Lung Blood and Vascular Medicine Institute University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Michael G. Risbano

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Heresi, G.A., AbuHalimeh, B.J. (2020). Current Approach to Chronic Thromboembolic Disease Without Pulmonary Hypertension. In: Ford, H.J., Heresi, G.A., Risbano, M.G. (eds) Pulmonary Hypertension. Respiratory Medicine. Humana, Cham. https://doi.org/10.1007/978-3-030-52787-7_5

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  • DOI: https://doi.org/10.1007/978-3-030-52787-7_5

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