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Pathology of chronic thromboembolic pulmonary hypertension 

Pathology of chronic thromboembolic pulmonary hypertension
Chapter:
Pathology of chronic thromboembolic pulmonary hypertension
Author(s):

Clive Handler

and Gerry Coghlan

DOI:
10.1093/med/9780199572564.003.009
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date: 22 October 2019

Pathology of CTEPH 36

CTEPH results from obstruction of the pulmonary arterial bed by non-resolving thromboemboli, and fibrous stenosis and/or complete obliteration of the PA. Acute pulmonary emboli (PEs) are probably the initiating event. Most patients with acute PEs recover spontaneously. The minority who do not, develop progressive pulmonary occlusions and a generalized hypertensive pulmonary arteriopathy with remodelling of the smaller vessels not affected by the thrombosis. This scenario would explain why some patients have severe PH despite what appears to be mild pulmonary vascular thrombosis. There are often associated distal thromboemboli in subsegmental vessels and are thus inaccessible from an operative standpoint....

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