A multimodal approach is key to curing CTEPH
Inova offers surgical and interventional procedures
Chronic thromboembolic pulmonary hypertension (CTEPH) is often misdiagnosed as pulmonary arterial hypertension, in part because a CTEPH diagnosis requires specialized testing including a ventilation/perfusion scan and a pulmonary angiogram, which are not widely available. Although a history of venous thromboembolic (VTE) events can predispose a patient to development of CTEPH, up to 50% of patients with CTEPH have no prior diagnosis of VTE events in the past, making an accurate diagnosis challenging.
“A missed or incorrect diagnosis is a real problem, because CTEPH is the only diagnosis under the umbrella of pulmonary hypertension that can be cured by surgery or, if a person is not a surgical candidate, by an interventional procedure,” said Oksana Shlobin, MD, Medical Director for the Pulmonary Hypertension Program and Director of Outreach and Education for the Inova Advanced Lung Disease and Transplant Program at Inova Fairfax Hospital.
Inova’s Pulmonary Hypertension Program offers patients a comprehensive evaluation through its multidisciplinary CTEPH service, which incorporates the expertise of pulmonary and critical care medicine, interventional pulmonology, cardiac surgery, invasive and noninvasive cardiology, thoracic radiology, and interventional radiology. This team provides state-of-the-art care through an array of surgical, interventional and medical therapies. The program has drawn patients not only from the greater Washington, DC, region, but also throughout Virginia, Maryland and West Virginia.
Two procedures to treat or cure CTEPH
Inova is the only program in the metropolitan Washington, DC, area that offers two specialized procedures for the treatment of CTEPH:
- Surgical pulmonary thromboendarterectomy (PTE) – the traditional surgical treatment for proximal CTEPH
- Balloon pulmonary angioplasty (BPA), a less invasive interventional approach for patients with affected vessels that are more distal and not amenable to surgical intervention
Inova Fairfax Hospital is currently one of the few institutions in the country offering BPA as a treatment option for CTEPH patients. In this procedure, clots in the lungs’ blood vessels are pushed apart, and the vessels are dilated.
Inova’s experienced team can also customize a multimodal treatment plan for eligible patients, beginning with PTE and then if needed complementing it with BPA or medications. This would enable, for example, an interventional cardiologist to address a residual clot in very distal vasculature that could not be accessed during surgical PTE. The team also offers medical therapies to complement and complete its portfolio of treatment options for patients who are not candidates for either PTE or BPA.
“The vast majority of patients will have a very successful outcome,” Dr. Shlobin said. “In most cases, their pulmonary hypertension is cured. In cases where the procedure is not curative, the severity of the patient’s pulmonary hypertension is decreased dramatically, improving mortality, morbidity and quality of life.”
A multidisciplinary approach is key
Inova’s Pulmonary Hypertension Program is an accredited Pulmonary Hypertension Association Center of Excellence. The program is truly multidisciplinary, incorporating advanced lung disease physicians with advanced heart failure specialists in a collaborative team environment.
Patients with CTEPH often have other comorbidities. To provide the best care, Inova’s team includes specialists who understand the physiology of those comorbidities and pulmonary hypertension’s disease process in the setting of lung disease or heart failure. The team also includes a dietitian, social workers, cardiopulmonary rehabilitation specialists and many others.
“In our institution, pulmonary hypertension providers are also a part of the lung transplant team. This approach enables us to seamlessly transition patients to lung transplant or lung and heart transplant for patients in whom medical management of the pulmonary hypertension is not successful,” said Dr. Shlobin.
To refer a patient, contact PHReferrals@Inova.org or call 571-472-0420.