Pulmonary Hypertension

Pulmonary Thromboendarterectomy

Pulmonary thromboendarterectomy

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Many people develop blood clots in their lungs (pulmonary emboli). In a small percentage of those people, the clots do not dissolve but stick to the vessel wall and obstruct blood flow. The result is chronic pulmonary thromboembolic disease, an uncommon cause of pulmonary hypertension and right-sided heart failure that may be treatable with surgery. Pulmonary thromboendarterectomy, the surgical procedure to remove this material, can effect a cure by restoring normal pulmonary artery pressures and reversing right-sided heart failure.

Pulmonary thromboendarterectomy is not commonly performed. As with many surgical procedures, success can depend on the experience of the surgeon. Mayo Clinic surgeons have a large collective experience treating pulmonary thromboendarterectomy.

Pulmonary thromboendarterectomy may be recommended for people who have severe symptoms or pulmonary hypertension that would shorten their lives. Pulmonary thromboendarterectomy is performed by cardiac surgeons using a heart-lung machine (cardiopulmonary bypass) and periods of circulatory arrest. This major surgical procedure carries significant risks as well as potential benefits. Mayo surgeons discuss the risks and benefits with patients when surgery is the most appropriate approach.

When deciding if surgery may be appropriate, the surgeon first determines whether it is possible to reach the fibrous material causing the blockage in the artery. Usually, a pulmonary angiogram can reveal whether or not surgery is an option.

The results of pulmonary thromboendarterectomy can be dramatic, with a return to near-normal pulmonary artery pressures and cardiac output. Warfarin for anticoagulation (blood thinning) may be the only long-term medication required. For that reason, in cases of chronic thromboembolic pulmonary hypertension, pulmonary thromboendarterectomy may be preferable to other options such as lung transplantation or long-term medical therapy.