Chronic Thromboembolic Pulmonary Hypertension

Abstract

Pulmonary thromboendarterectomy (PTE) offers a highly effective form of treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH). Symptoms are due to progressive right-sided heart failure secondary to an obstructed pulmonary vascular tree. Patient evaluation includes nuclear scintigraphy, pulmonary angiography, and right heart catheterization and should differentiate patients with CTEPH from those with other forms of pulmonary hypertension. The operation typically requires bilateral thromboendarterectomy using cardiopulmonary bypass and periods of circulatory arrest. The chronic, organized thrombi that obstruct the major pulmonary vessels (main, lobar, and segmental) are removed, and there is immediate improvement in pulmonary hemodynamics. Mortality of PTE has been reported as low as 5% and the majority of patients experience significant long-term benefits in hemodynamics and symptoms.

Key Words:

Pulmonary hypertension - thromboendarterectomy - surgery - pulmonary embolism