REVIEW   

Minerva Pneumologica 2017 June;56(2):122-33

DOI: 10.23736/S0026-4954.17.01777-1

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Surgical treatment of chronic thromboembolic pulmonary hypertension

Jason M. ALI, Choo Y. NG, David P. JENKINS ✉

Cardiothoracic Surgery, Papworth Hospital, Papworth Everard, UK

Chronic thromboembolic pulmonary hypertension (CTEPH) is the only potentially curable type of pulmonary hypertension. CTEPH evolves as a late complication of pulmonary embolism, with a transition from acute thromboembolism to a chronic endothelialized endovascular scar. The commonest presenting symptoms are dyspnea, reduced exercise tolerance and fatigue, common to a range of cardiopulmonary diseases which result in a diagnosis of CTEPH frequently being delayed. Diagnostic imaging is important for both making the diagnosis, but also for assessing the distribution and burden of disease. CTEPH can potentially be cured with a surgical procedure: a pulmonary endarterectomy where the organized thromboembolic material and related fibrous tissue are cleared from the pulmonary arterial tree, with concomitant reduction in pulmonary vascular resistance (PVR) and amelioration of impaired right heart hemodynamic function. Not all patients are suitable for surgical management. Operability is assessed by considering if the chronic thrombotic lesions are surgically accessible and ensuring the presence and severity of hemodynamic impairment correlate with the burden of thromboembolic disease. Considering the magnitude of the intervention, outcomes following pulmonary endarterectomy at experienced centers are excellent with low in-hospital mortality. Significant improvements in hemodynamic parameters are immediately observed postoperatively, which translate into long term functional benefits for patients.

KEY WORDS: Hypertension, pulmonary - Endarterectomy - Surgical procedures, operative