European Journal of Cardio-Thoracic Surgery, Vol 10, 32-37, Copyright © 1996 by European Association for Cardio-thoracic Surgery
Long-term follow-up in pulmonary embolectomy: is NYHA (dyspnea) classification reliable?
JM Habicht, R Hammerli, A Perruchoud, J Muller and P Stulz
Department of Surgery, University Hospital, Basel, Switzerland.
In this retrospective investigation we carried out a thorough physical
examination, ventilation/perfusion scintigraphy, echocardiography and lung
function test in 19 of all 21 long-term survivors consecutively operated on
for massive pulmonary embolism between 1968 and 1992. Two patients refused
these investigations but were both asymptomatic. The mean follow-up was 8.4
years and 12 (57%) of the patients were in NYHA I and 6 (29%) in NYHA II.
The three patients in NYHA III (there were none in class IV) underwent
right heart catheterization and pulmonary angiography additionally. Our
findings suggest that, generally, the results of scintigraphy,
echocardiography, lung function tests and physical examination correspond
to the subjective status expressed as NYHA (dyspnea) class, when evaluated
in combination. However, in classes III and IV other causes of dyspnea
apart from residual pulmonary vascular obstruction can be found. These may
also occur in combination. We observed severe chronic obstructive lung
disease, hemidiaphragmatic paralysis, obesity, pulmonary hypertension of
unknown origin, atrial septal defect (ASD) and neurologic residual deficit
with depressive state. Thus, in evaluating long-term results of pulmonary
embolectomy with regard to vascular desobliteration, NYHA classification
does not seem to be reliable for classes III and IV.
