[Chronic thromboembolic pulmonary hypertension may be cured with surgery]

Abstract

Chronic thromboembolic pulmonary hypertension is a subtype of pulmonary hypertension that affects 0,5-4% of patients who have had a pulmonary embolism. Emboli in the pulmonary arteries lead to fibrosis, obstruction and remodeling of the pulmonary arteries which causes increased pulmonary arterial blood pressure and increased pulmonary vascular resistance. Cardiac ultrasound is used as initial screening in order to identify high pulmonary artery pressures and right heart dysfunction. Lung scintigraphy, computed tomography, and pulmonary angiography are used to verify and describe disease severity. Surgical treatment entails circulatory arrest with endarterectomy starting proximal in the pulmonary arteries and continuing distally throughout the pulmonary arterial tree. Removal of obstruction leads to decreased pulmonary artery pressure and pulmonary vascular resistance, resulting in improved quality of life and near normal life expectancy.