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2016 ; 12
(4
): 213-218
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Surgical Treatment of Chronic Thromboembolic Pulmonary Hypertension: Pulmonary
Thromboendarterectomy
#MMPMID28289496
Madani MM
Methodist Debakey Cardiovasc J
2016[Oct]; 12
(4
): 213-218
PMID28289496
show ga
Pulmonary thromboendarterectomy (PTE), also referred to as pulmonary
endarterectomy, is the definitive treatment for chronic thromboembolic pulmonary
hypertension (CTEPH). The true incidence of CTEPH is unknown and difficult to
ascertain; however, most experts agree that approximately 4% to 5% of all
patients who have an acute episode of pulmonary embolism (PE) will continue to
develop CTEPH. Based on an incidence rate of about 0.1% for acute PE, this
translates into a CTEPH incidence of approximately 10,000 to 15,000 annually in
the United States alone. Furthermore, there are patients with CTEPH who have no
history of prior PE or deep vein thrombosis, adding to the estimated number.
Despite these facts, the disease remains significantly underdiagnosed, and
currently there are only about 300 PTEs performed nationwide, the majority of
which are done at the University of California, San Diego (UCSD) Health System.
The technical aspects of the procedure can be somewhat challenging and require
meticulous and complete dissection of the entire pulmonary vascular tree, with
the patient under profound hypothermic circulatory arrest. However, the
determination of true CTEPH patients and those who would benefit from surgery can
also be challenging and relies heavily on the experience of the CTEPH team. In
this article, we will highlight some key points about the disease and describe
the surgical techniques of PTE.