Evaluating preoperative imaging in patients with chronic thromboembolic pulmonary hypertension: Is computed tomography pulmonary angiography a reliable alternative to pulmonary angiography?
5 affiliations
- 1Division of Cardiac Surgery, Jewish General Hospital, McGill University, Montréal, Québec, Canada.
- 2Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada.
- 3Division of Cardiac Surgery, Houston Methodist, Houston, Tex.
- 4Division of Pulmonary Diseases, Department of Medicine, Jewish General Hospital, McGill University, Montréal, Québec, Canada.
- 5Center of Excellence in Thrombosis and Anticoagulation Care, Jewish General Hospital, McGill University, Montréal, Québec, Canada.
Abstract
Objectives
Chronic thromboembolic pulmonary hypertension is a potentially curable form of pulmonary hypertension, with pulmonary endarterectomy serving as a key surgical treatment option. Accurate preoperative imaging is critical for determining surgical candidacy and optimizing operative outcomes. Although digital subtraction pulmonary angiography remains the gold standard, computed tomography pulmonary angiography has emerged as a noninvasive alternative. This study compares the concordance of computed tomography pulmonary angiography and digital subtraction pulmonary angiography with intraoperative specimen findings to determine their diagnostic accuracy.Methods
We conducted a retrospective cohort study of patients who underwent pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension at a single Canadian center between 2014 and 2017. All patients underwent preoperative computed tomography pulmonary angiography and digital subtraction pulmonary angiography as part of their routine evaluation. Imaging findings were compared with operative findings using a territory-based anatomic assessment across major pulmonary artery segments. Functional and hemodynamic outcomes were also assessed before and after surgery.Results
Seventeen patients (mean age 52.8 years [±3.7]; 53% female) were included. Computed tomography pulmonary angiography demonstrated greater agreement with operative findings in the right main pulmonary artery, left upper lobe, and lingula. Digital subtraction pulmonary angiography demonstrated greater agreement in the right upper lobe, whereas both modalities showed similar agreement in the left main pulmonary artery and left lower lobe. Patients experienced postoperative improvements in New York Heart Association functional class, pulmonary artery pressures, and cardiac index. Despite overall agreement between imaging and operative findings, discrepancies persisted across several vascular territories.Conclusions
Computed tomography pulmonary angiography demonstrated substantial agreement with operative findings in central and lobar pulmonary arterial territories, supporting its role as an important frontline imaging modality in the evaluation of chronic thromboembolic pulmonary hypertension. However, persistent discrepancies between imaging and operative assessment, particularly in more distal territories, support the continued use of a multimodal approach integrating computed tomography pulmonary angiography, digital subtraction pulmonary angiography, hemodynamic assessment, and multidisciplinary evaluation when determining operability and treatment strategy.
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BibTeX
@article{alamri2026evaluating,
title = {{Evaluating preoperative imaging in patients with chronic thromboembolic pulmonary hypertension: Is computed tomography pulmonary angiography a reliable alternative to pulmonary angiography?}},
author = {Rawan Alamri and Hamnah Majeed and Fayeza Ahmad and Ziyab Sarfaraz and Andrew Hirsch and Jean-François Morin},
journal = {JTCVS open},
year = {2026},
month = jul,
doi = {10.1016/j.xjon.2026.101960},
url = {https://europepmc.org/article/MED/42948425},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Evaluating preoperative imaging in patients with chronic thromboembolic pulmonary hypertension: Is computed tomography pulmonary angiography a reliable alternative to pulmonary angiography?
AU - Rawan Alamri
AU - Hamnah Majeed
AU - Fayeza Ahmad
AU - Ziyab Sarfaraz
AU - Andrew Hirsch
AU - Jean-François Morin
PY - 2026
DA - 2026/07/10
JO - JTCVS open
DO - 10.1016/j.xjon.2026.101960
UR - https://europepmc.org/article/MED/42948425
AB - Objectives Chronic thromboembolic pulmonary hypertension is a potentially curable form of pulmonary hypertension, with pulmonary endarterectomy serving as a key surgical treatment option. Accurate preoperative imaging is critical for determining surgical candidacy and optimizing operative outcomes. Although digital subtraction pulmonary angiography remains the gold standard, computed tomography pulmonary angiography has emerged as a noninvasive alternative. This study compares the concordance of computed tomography pulmonary angiography and digital subtraction pulmonary angiography with intraoperative specimen findings to determine their diagnostic accuracy.Methods We conducted a retrospective cohort study of patients who underwent pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension at a single Canadian center between 2014 and 2017. All patients underwent preoperative computed tomography pulmonary angiography and digital subtraction pulmonary angiography as part of their routine evaluation. Imaging findings were compared with operative findings using a territory-based anatomic assessment across major pulmonary artery segments. Functional and hemodynamic outcomes were also assessed before and after surgery.Results Seventeen patients (mean age 52.8 years [±3.7]; 53% female) were included. Computed tomography pulmonary angiography demonstrated greater agreement with operative findings in the right main pulmonary artery, left upper lobe, and lingula. Digital subtraction pulmonary angiography demonstrated greater agreement in the right upper lobe, whereas both modalities showed similar agreement in the left main pulmonary artery and left lower lobe. Patients experienced postoperative improvements in New York Heart Association functional class, pulmonary artery pressures, and cardiac index. Despite overall agreement between imaging and operative findings, discrepancies persisted across several vascular territories.Conclusions Computed tomography pulmonary angiography demonstrated substantial agreement with operative findings in central and lobar pulmonary arterial territories, supporting its role as an important frontline imaging modality in the evaluation of chronic thromboembolic pulmonary hypertension. However, persistent discrepancies between imaging and operative assessment, particularly in more distal territories, support the continued use of a multimodal approach integrating computed tomography pulmonary angiography, digital subtraction pulmonary angiography, hemodynamic assessment, and multidisciplinary evaluation when determining operability and treatment strategy.
SN - 2666-2736
ER -