Some patients may have repeated episodes of blood clots travelling to the lungs and developing severe lung artery abnormalities. These results in elevated lung pressures. We call this chronic thromboembolic pulmonary hypertension or CTEPH. Patients have to undergo a right heart catheterization study, a pulmonary angiogram (contrast injection of the arteries) as well as a ventilation perfusion scan ( radioisotope scan) for the diagnosis to be confirmed. Some patients may benefit from surgery. In those who have smaller, distal vessel disease, balloon pulmonary angioplasty may be considered.
A catheter is introduced in the lung arteries and contrast is administered to highlight the diseased areas (webs, slits and obstruction). These lesions are crossed with a very fine wire. A small size balloon is inflated to break up the webs and obstruction. No stents are required. As most patients have many obstructed lesions, repeat dilation of the blocked vessels are needed. Medical treatment may also be offered for some selected patients to improve their symptoms.
Irene Lang, Bernhard C. Meyer, Takeshi Ogo, Hiromi Matsubara, Marcin Kurzyna, Hossein-Ardeschir Ghofrani, Eckhard Mayer, Philippe Brenot
European Respiratory Review 2017 26: 160119; DOI: 10.1183/16000617.0119-2016
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Dr Pipin Kojodjojo specializes in cardiac electrophysiology and management of heart rhythm disorders in both adolescents and adults.
Experienced in managing patients with atrial fibrillation and unexplained blackouts (syncope).
Dr Chuang Hsuan-Hung is a heart failure intensivist trained in advanced cardiovascular imaging. He specialises in heart failure and heart transplant intensive care.
Experienced in managing genetic heart disease, cardio-oncology and sports cardiology.
Dr Stanley Chia is an interventional cardiologist with a distinguished academic record.
He is skilled and experienced in managing complex cardiovascular disease and difficult coronary interventional procedures like stenting of the left main artery.
Dr Jeremy Chow is an electrophysiologist specialising in the implantation and management of electronic cardiac devices.
Experienced in arrhythmia management, stroke prevention and trained in procedures such as electrophysiology studies and ablations.
Dr Tan Chong Hiok is an interventional cardiolgist trained and specialises in stenting of the left main artery and chronic total occlusion.
He is experienced in managing complex cases in patients who have declined or are unsuitable for bypass surgery.
Dr Goh Ping Ping is an echocardiologist trained in imaging of the heart.
She is a strong advocate of preventive cardiology and awareness for women’s heart health. She manages a broad spectrum of cardiovascular disease including heart attack patients.
Dr Chan Wan Xian is a heart failure intensivist specialised in managing complex heart failure and patients with mechanical hearts.
Trained in cardiac imaging and she is experienced is treating women at risk of heart disease, especially during pregnancy.
Dr Edgar Tay is an interventional cardiologist specialised in structual heart disease, adult congenital and pulmonary hypertension.
Trained in procedures like TAVI, Mitralclip and pulmonary angioplasty for chronic thromboembolic pulmonary hypertension.
Dr Cliff Wong is an echocardiologist trained in imaging of the heart.
He specializes in cardiac imaging (echocardiography and cardiovascular computed tomography). Experienced in managing cardiomyopathy, heart failure, valvular heart diseases and cardio-oncology.
