Pulmonary Thromboendarterectomy

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is an important and often underappreciated cause of severe pulmonary hypertension. The disease is a result of incomplete resolution or recurrent pulmonary emboli. It is imperative to identify patients with CTEPH because it is one of the only causes of pulmonary hypertension that is curable. The treatment of choice is pulmonary thromboendarterectomy. The procedure involves removing any chronic thrombotic material and removing the intimal layer of the vasculature. Patients with CTEPH can be particularly challenging to manage in the perioperative setting and often present to the operating room with significant right heart dysfunction, severely elevated pulmonary vascular resistance, and reduced cardiac output.1 Increased knowledge about the unique disease and procedure can aid in optimizing the management of these patients in the perioperative period.2