PARTIAL REVERSIBILITY OF CHRONIC PULMONARY-HYPERTENSION CAUSED BY PULMONARY THROMBOEMBOLIC DISEASE

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Abstract
Vasodilators including isoproterenol, nitroprusside, nitroglycerin and O2 were administered to 5 patients with chronic pulmonary hypertension secondary to pulmonary embolism. The patients'' mean pulmonary artery pressure (PAP) was 54 .+-. 8 mm Hg, and their average total pulmonary resistance (TPR) was 17 .+-. 11 mm Hg/g per min. Each patient experienced a decrease in TPR in response to at least 1 of the vasodilators. The mean maximal decrease was to 57 .+-. 10% of the baseline value. Although these decrements in TPR were accompanied by an increase in cardiac output in all but 1 patient, changes in PAP were variable. Treatment with nitroglycerin was continued in 3 of the 5 patients and all 3 reported improvement in their exercise tolerance. The elevated TPR seen in patients with chronic embolic pulmonary hypertension apparently is due to increased pulmonary vascular tone in addition to fixed vascular tone in addition to fixed vascular obstruction.

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