Robert P. Frantz is the director of the Mayo Pulmonary Hypertension Clinic, which has a robust referral practice of patients with pulmonary arterial hypertension. Dr. Frantz has served as the Mayo site PI on numerous multicenter trials in PH including the majority of trials resulting in FDA approved PH therapies. He also performs complex hemodynamic studies in the catheterization laboratory including right heart catheterizations for patients with pulmonary arterial hypertension and also patients with left heart failure. He also evaluates and manages patients with CTEPH, with particular interest in the role of balloon pulmonary angioplasty.
My name is Dr. Robert Frantz, and I am the director of the Pulmonary Hypertension Clinic at the Mayo Clinic in Rochester, Minnesota and I’ve been here over 20 years. I really spend a lot of time taking care of patients with various forms of pulmonary hypertension. One form of pulmonary hypertension that we’re seeing more often than we used to is what we call chronic thromboembolic pulmonary hypertension [CTEPH].
That can look just like pulmonary hypertension of other causes in terms of having elevated pulmonary artery pressures and normal left heart filling pressures. Then the development of shortness of breath and failure of the right side of the heart leading to fluid retention and poor activity tolerance. But people don’t come waving a flag saying, “Hey, the reason I have pulmonary hypertension is because part of my lung vessels are plugged up with old clots that I didn’t know I had.” So it is a form of pulmonary hypertension that can be overlooked.
We often say that nobody should be diagnosed with idiopathic pulmonary arterial hypertension (or pulmonary hypertension of unknown cause), without making sure they don’t have clots in their lungs. The interesting thing is that many patients could have obstruction of the lung vessels with old fibrotic clots and never have had a clinical history of a clot in their leg veins or having had…