Pulmonary Hypertension

Pulmonary Thromboendarterectomy

Many people experience blood clots in their lungs (pulmonary emboli). In a small percentage, the clots do not dissolve but stick to the vessel wall and obstruct blood flow. The result is chronic pulmonary thromboembolic disease — an uncommon but potentially surgically treatable cause of pulmonary hypertension and right heart failure. Pulmonary thromboendarterectomy, the surgical procedure to remove this material, can provide a cure by restoring normal pulmonary artery pressures and reversing right heart failure.

Pulmonary thromboendarterectomy is not a common procedure. Like many surgical procedures, success depends in part on the experience of the surgeon. Surgeons at Mayo Clinic have a large collective experience with pulmonary thromboendarterectomy and an excellent record of results.

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Pulmonary thromboendarterectomy may be recommended for people who have severe symptoms or pulmonary hypertension which would shorten their lives. Pulmonary thromboendarterectomy is performed by cardiac surgeons using the heart-lung machine (cardiopulmonary bypass). This major surgical procedure carries significant risks as well as potential benefits.

The surgeon must be able to reach the fibrous material causing the blockage in the artery — if the blockage is too far out in the small blood vessels of the lungs, the surgeon may not be able to reach it. Usually a pulmonary angiogram will be able to reveal whether or not surgery is an option.

The results of pulmonary thromboendarterectomy can be dramatic, with near normalization of pulmonary artery pressures and cardiac output. The benefits appear to be sustained. Warfarin (a blood thinner) for anticoagulation is usually the only long-term medication required. Therefore, pulmonary thromboendarterectomy is preferable to other alternatives such as lung transplantation or long-term medical therapy for chronic thromboembolic pulmonary hypertension.