Korean J Thorac Cardiovasc Surg.  2006 Aug;39(8):626-632.

Pulmonary Thromboendarterectomy for Pulmonary Hypertension Caused by Chronic Pulmonary Thromboembolism

• Song SH
• Park PW
• Jun TG
• Lee YT
• Sung K
• Yang JH
• Choi JH
• Kim JS
• Kim HJ

Abstract

BACKGROUND: Pulmonary hypertension caused by chronic pulmonary embolism is underrecognized and carries a poor prognosis. Medical therapy is generally unsatisfactory and palliative. With the improvemet of operative technique and postoperative management, pulmonary endarterectomy has been the treatment of choice for this condition. MATERIAL AND METHOD: Between January 2001 and Decomber 2005, eleven patients were received pulmonary endarterectomy. All patients had chronic dyspnea and exercise intolerance. Diagnosis was made with cardiac echocardiography, lung perfusion scan and computed tomography. Before the operation, Greenfield vena cava filter were placed in all patient except one. Deep hypothermic circulatory arrest was used for the distal-most portion of the endarterectomy procedure. More than moderate degree of tricuspid reguirgitation was repaired during operation. RESULT: There was no early and late death. Right ventricular systolic pressure was reduced significantly after operation from 91+/-21 mmHg to 40+/-17 mmHg on echocardiography (p=0.001). NYHA class and tricuspid reguirgitaion were improved postoperatively. Although mild reperfusion injury in three case and postoperative delirium in one case were observed, all of them recovered without complication.
CONCLUSION
Pulmonary thromboendarterctomy offers to patient an acceptable morbidity rate and anticipation of clinical improvement. This method is safe and effective operation for pulmonary hypertension caused by chronic pulmonary thromboembolism.

Keyword

Pulmonary embolism; Endarterectomy; Hypertension, pulmonary

MeSH Terms

Blood Pressure
Circulatory Arrest, Deep Hypothermia Induced
Delirium
Diagnosis
Dyspnea
Echocardiography
Endarterectomy*
Humans
Hypertension, Pulmonary*
Lung
Perfusion
Prognosis
Pulmonary Embolism*
Reperfusion Injury
Vena Cava Filters