# A management of a patient with chronic thromboembolic pulmonary hypertension prior to surgical resection for lung cancer

## TL;DR

A 55-year-old woman with both CTEPH and lung cancer was successfully treated by prioritizing CTEPH management before lung cancer surgery.

## Contribution

This case report presents a management strategy for coexisting CTEPH and lung cancer.

## Key findings

- CTEPH treatment with riociguat and BPA reduced mean pulmonary artery pressure from 39 to 27 mmHg.
- Lung cancer surgery was performed without significant worsening of right heart failure.
- No recurrence of lung cancer was observed post-surgery.

## Abstract

The basic treatment for chronic thromboembolic pulmonary hypertension (CTEPH) includes lifelong anticoagulant therapy and pulmonary endarterectomy; moreover, balloon pulmonary angioplasty (BPA) and vasodilators are also known to be effective. Surgery is the standard treatment for localized lung cancer. However, no established treatment guidelines exist for cases of coexisting CTEPH and lung cancer.

The patient was a 55-year-old woman who experienced dyspnea on exertion. She was diagnosed with non-small cell lung cancer, and surgery was scheduled; however, she was also diagnosed with CTEPH during preoperative examinations. She was referred to our hospital, where right heart catheterization revealed a mean pulmonary artery pressure (mPAP) of 39 mmHg. We prioritized the treatment of CTEPH, starting oral riociguat followed by BPA three times. The mPAP decreased to 27 mmHg. Then, right upper lobectomy and lymph node dissection were performed. After surgery, there was no significant worsening of right heart failure, and no recurrence of the lung cancer.

This case report presents a method for managing both CTEPH and primary lung cancer. The essence was the intensification of CTEPH treatment in anticipation of lobectomy.