Pulmonary Thromboendarterectomy

It seems difficult to believe, but people can live (albeit not very easily) with blood clots in their lungs. This disease, called chronic thromboembolic disease, causes high blood pressure in the lungs (pulmonary hypertension) and the associated symptoms, including eventual heart failure. In chronic thromboembolic disease, small blood clots travel to the lungs, stick together in the arterial walls, and block blood flow in the pulmonary arteries. The pulmonary arteries branch out in and supply blood to the lungs. When the lungs cannot get adequate blood flow due to these blockages, the result is pulmonary hypertension and, eventually, right-sided heart failure. Chronic thromboembolic disease can be treated surgically.

A pulmonary angiogram is performed to determine whether surgery is an option and if the blockages can be reached by the surgeon (those in the smallest blood vessels of the lungs are untreatable). The blockages can be 10 inches long or longer and occur in both lungs simultaneously.

The surgical procedure to treat chronic thromboembolic disease is called a pulmonary thromboendarterectomy or “PTE” (pulmonary=lung; thrombo=blood clot; endarterectomy= inner/artery/excision). PTE is a major and serious procedure that is recommended for patients with severe symptoms and/or extremely debilitating pulmonary hypertension. The surgery takes 8 hours or more, is performed under cardiopulmonary bypass by a cardiothoracic surgeon, and carries significant risks and benefits. Among other factors, the success of this uncommon procedure depends on the experience of the surgeon.

A successful PTE can significantly improve a patient’s health by normalizing pulmonary artery pressure and increasing cardiac output. Although the patient will most likely need long-term anticoagulation medication after having the procedure, the surgery and medication option is often preferable to lung transplantation or long-term medical therapy.


Resources

Mayo Clinic www.mayoclinic.org/pulmonary-hypertension/pulthrombo.html
UC San Diego Medical Center http://health.ucsd.edu/specialties/pte/desc.htm