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Case Reports
. 2023 Mar 15;11(5):216.
doi: 10.21037/atm-22-4370. Epub 2023 Mar 7.

Early experience with pulmonary endarterectomy in Bulgaria-case series

Georgi Ignatov  1 , Choo Yen Ng  2 , Zihui Tan  3 , Vasil Velchev  4 , Teodora Kurkchieva  5 , Jon C Whitbread  6 , Kamen P Valchanov  3
Affiliations
Case Reports

Early experience with pulmonary endarterectomy in Bulgaria-case series

Georgi Ignatov et al. Ann Transl Med. .

Abstract

Background: Pulmonary arterial hypertension (PAH) is a condition that limits the quality of life and life expectancy. The predicted mortality at 1 year is estimated at 30-40% without treatment. Of the types of PAH, chronic thromboembolic pulmonary hypertension (CTEPH) is most amenable to treatment and guidelines recommend pulmonary endarterectomy (PEA) surgery for 'operable' patients (where disease is found in the proximal pulmonary vessels). Traditionally these patients were referred to a European centre with the complexities of international travel, pre- and post-operative care, and funding. We sought to establish a national PEA programme to serve the Bulgarian population and avoid some of the problems of international healthcare.

Case description: A total of 11 patients underwent PEA in 2 cardiac centres in Bulgaria (Acibadem Hospital and Government Hospital Lozenetz Sofia). The age of patients ranged from 22 to 80. The preoperative pulmonary vascular resistance (PVR) ranged from 309 to 1,906 dynes/sec/cm-5. For the surviving patients the average PVR reduction was 615 dynes/sec/cm-5 at 6 months, the average intensive care unit (ICU) stay 6.7 days, and hospitalisation 15.2 days. Nine out of 11 patients survived to hospital discharge and 6 months follow, all with normalised PVR and exercise tolerance.

Conclusions: We present our results of initial experience with PEA in Bulgaria with encouraging results. Our work shows that inter-European relationship for healthcare can be productive and offer safe treatment on local level.

Keywords: Case series; pulmonary arterial hypertension (PAH); pulmonary endarterectomy (PEA).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-22-4370/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Pulmonary endarterectomy specimens.
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References

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