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Pulmonary Angiography in Severe Chronic Pulmonary Hypertension

PASCAL NICOD, M. D.; KIRK PETERSON, M.D.; MICHAEL LEVINE, M.D.; HOWARD DITTRICH, M.D.; MAURICE BUCHBINDER, M.D.; FRANCOIS CHAPPUIS, M.D.; and KENNETH MOSER, M.D.
[+] Article and Author Information

▸Requests for reprints should be addressed to Pascal Nicod, M.D.; University of California, San Diego, Medical Center, 225 Dickinson Street; San Diego, CA 92103.


San Diego, California


©1987 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1987;107(4):565-568. doi:10.7326/0003-4819-107-4-565
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We have analyzed the safety of doing pulmonary angiography in 67 consecutive patients with moderate-to-severe primary pulmonary hypertension or hypertension secondary to chronic thromboembolic occlusions of the pulmonary arteries. The average (± SD) pulmonary arterial systolic and diastolic pressures were 74 ± 19 and 34 ± 10 mm Hg, respectively. Fourteen patients had a right ventricular end-diastolic pressure of 20 mm Hg or more. Selective left and right main pulmonary artery injections were done using ionic contrast agents in 56 patients and nonionic contrast agents in 11. No major rhythm disturbances or systemic hypotension requiring therapy occurred, and there were no deaths. Thrombotic occlusions of the pulmonary arteries were identified in 52 patients and confirmed in all 42 of those who had a thromboendarterectomy. At autopsy, 3 of the 15 patients who had normal angiograms were found not to have had thrombotic occlusions. We conclude that pulmonary angiography can be done safely despite the presence of severe pulmonary hypertension and right ventricular failure, and that the procedure leads to the identification of chronic, major-vessel thromboembolic pulmonary hypertension that may be alleviated by thromboendarterectomy.

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