Christian Olaf Schoenfeld MD, Presenter: Nothing to Disclose

Serghei Cebotari MD, Abstract Co-Author: Nothing to Disclose

Jan Hinrichs MD, Abstract Co-Author: Nothing to Disclose

Julius Renne MD, Abstract Co-Author: Nothing to Disclose

Marcel Gutberlet DiplPhys, Abstract Co-Author: Nothing to Disclose

Andreas Voskrebenzev, Abstract Co-Author: Nothing to Disclose

Tobias Welte MD, Abstract Co-Author: Nothing to Disclose

Marius Hoeper, Abstract Co-Author: Nothing to Disclose

Axel Haverich, Abstract Co-Author: Nothing to Disclose

Frank K. Wacker MD, Abstract Co-Author: Research Grant, Siemens AG Research Grant, Pro Medicus Limited

Jens Vogel-Claussen MD, Abstract Co-Author: Nothing to Disclose

An established method for treatment of patients with chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA). The aim of the study is to evaluate the surgical success after PEA by means of cardio-pulmonary MRI.

16 patients (53±17 years; 9 male) with CTEPH were examined with a 1.5T MRI before and 17±12 days after PEA. After contrast medium bolus administration the lung was evaluated with a dynamic 3D FLASH sequence (TWIST) with an update rate of 1.2s per 3D data set and the pulmonary blood flow (PBF) was determined using a deconvolution algorithm. Furthermore, the left (LV), right ventricular (RV) function and cardiac mass were determined. Mean pulmonary artery pressure (mPAP) was measured before and after PEA by right (r.) heart catheterization. Means ± SD, paired t-test.

Regional PBF after PEA increased significantly in: total lung parenchyma by 48% (37.3±12.8 to 55.1±19.4ml/min/100ml, p=0.001), r. upper lobe (UL) by 29% (p=0.048) (cardiac output (CO) adjusted: 2% (p=0.873), the middle lobe by 70% (p=0.003)(CO adjusted: 30%, p=0.079), the r. lower lobe (LL) to 74% (p=0.003) (CO adjusted: 36% (p=0.02,) lUL by 25% (p=0.01) (CO adjusted: 5% (p=0.653) and the lLL by 59% (p<0.001) (CO adjusted: 25% (p=0.008). After PEA RV mass decreased by 17% (46.5 to 38.5g/m², p=0.006). Ventricular mass index decreased by 19% (0.69 to 0.56, p=0.001) and RV function increased: RV end-diastolic volume by -14.6% (91.0 to 77.7ml/m², p=0.037), RV end-systolic volume by -38% (63.7 to 39.5ml/m², p=0.0008), RV ejection fraction by +25% (40.2 to 50.2%, p=0.0004). Cardiac index increased by 28% (2.8 to 3.3l/min/m², p=0.01) and LV systolic eccentricity index decreased by 19% (1.84 to 1.49, p=0.02) as a sign of improved pulmonary hemodynamics after PEA. Mean mPAP decreased significantly by 44% (45.4 to 25.4 mmHg, p<0.0001) after PEA.

Improvement of PBF is observed predominantly in the lower lungs 2 weeks after PEA: Even after adjusting for CO regional PBF improved in bilateral lower lobes and ML. Increased flow after PEA in bilateral upper lobes was proportional to increased CO in response to decreased pulmonary pressures in our patient cohort.

In patients with CTEPH quantitative cardio-pulmonary MRI is a novel noninvasive clinical tool for comprehensive patient assessment pre and post PEA.

Schoenfeld, C, Cebotari, S, Hinrichs, J, Renne, J, Gutberlet, M, Voskrebenzev, A, Welte, T, Hoeper, M, Haverich, A, Wacker, F, Vogel-Claussen, J, Quantification of MRI Derived Regional Pulmonary Parenchymal Perfusion and Cardiac Function for Assessment of Hemodynamic Changes before and after Pulmonary Endarterectomy in Patients with Chronic Thromboembolic Pulmonary Hypertension.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14002749.html