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Review
. 2025 Sep 28;14(19):6862.
doi: 10.3390/jcm14196862.

The Surgical Management of Chronic Thromboembolic Pulmonary Hypertension

Kevin C McGann  1 , Chen Chia Wang  1 , John M Trahanas  1 , Swaroop Bommareddi  1 , Brian Lima  1 , Awab Ahmad  1 , Clifford W Chin  1 , Ivan M Robbins  2 , Meredith E Pugh  2 , Anna R Hemnes  2 , Blake Funke  2 , Ashish S Shah  1 , Aaron M Williams  1
Affiliations
Review

The Surgical Management of Chronic Thromboembolic Pulmonary Hypertension

Kevin C McGann et al. J Clin Med. .

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is a type of pulmonary hypertension due to unresolved thromboembolic disease that presents with signs of pulmonary artery obstruction and right heart dysfunction. Pulmonary thromboendoarterectomy (PTE) with deep hypothermic circulatory arrest remains the standard of care for the treatment of CTEPH, with significant improvements in symptoms and functional status after surgery. This review outlines the diagnostic workup, considerations during operative planning, surgical technique, and postoperative management of CTEPH patients.

Keywords: chronic thromboembolic pulmonary hypertension (CTEPH); pulmonary endarterectomy (PEA); pulmonary hypertension (PH); pulmonary thromboendarterectomy (PTE); surgical technique; thromboembolic disease.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Diagnostic algorithm for the evaluation of CTEPH. RVH = right ventricular hypertrophy; RBBB = right bundle branch block; mPAP = mean pulmonary artery pressure; PAWP = pulmonary artery wedge pressure; PVR = pulmonary vascular resistance.
Figure 2
Figure 2
Treatment evaluation algorithm for CTEPH. BPA = balloon pulmonary angioplasty; PEA = pulmonary endarterectomy. Adapted from Ref. [86]. 2019, American College of Cardiology Foundation.
Figure 3
Figure 3
Pulmonary thromboendarterectomy specimens involving level 1 disease from the main pulmonary arteries to the subsegmental pulmonary artery branches.
See this image and copyright information in PMC

References

    1. Papamatheakis D.G., Poch D.S., Fernandes T.M., Kerr K.M., Kim N.H., Fedullo P.F. Chronic Thromboembolic Pulmonary Hypertension. J. Am. Coll. Cardiol. 2020;76:2155–2169. doi: 10.1016/j.jacc.2020.08.074. - DOI - PubMed
    1. Benotti J.R., Ockene I.S., Alpert J.S., Dalen J.E. The Clinical Profile of Unresolved Pulmonary Embolism. Chest. 1983;84:669–678. doi: 10.1378/chest.84.6.669. - DOI - PubMed
    1. Guérin L., Couturaud F., Parent F., Revel M.-P., Gillaizeau F., Planquette B., Pontal D., Guégan M., Simonneau G., Meyer G., et al. Prevalence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: Prevalence of CTEPH after pulmonary embolism. Thromb. Haemost. 2014;112:598–605. doi: 10.1160/TH13-07-0538. - DOI - PubMed
    1. Pengo V., Lensing A.W.A., Prins M.H., Marchiori A., Davidson B.L., Tiozzo F., Albanese P., Biasiolo A., Pegoraro C., Iliceto S., et al. Incidence of Chronic Thromboembolic Pulmonary Hypertension after Pulmonary Embolism. N. Engl. J. Med. 2004;350:2257–2264. doi: 10.1056/NEJMoa032274. - DOI - PubMed
    1. Ende-Verhaar Y.M., Cannegieter S.C., Vonk Noordegraaf A., Delcroix M., Pruszczyk P., Mairuhu A.T.A., Huisman M.V., Klok F.A. Incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: A contemporary view of the published literature. Eur. Respir. J. 2017;49:1601792. doi: 10.1183/13993003.01792-2016. - DOI - PubMed

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