Pulmonary Thromboendarterectomy

Pulmonary embolism (PE) affects 0.5-1
per 1000 people in the general population
each year, and is one of the most common
preventable causes of death among
hospitalized patients. Unfortunately the
diagnosis is missed more often than it is
made, because PE often causes only vague
and nonspecific symptoms. The clinical
diagnosis of PE is unreliable and must be
confirmed objectively with ventilation
perfusion scanning or CT-angiography.
Cardiogenic shock or systolic hypotension
(BP <90mmHg), and presence of rightventricular
dysfunction or two principal
criteria which govern the severity of PE.
Chronic thromboembolic disease develops
in only 0.5% of patients with a clinically
recognized acute P.E. Most patients
diagnosed with chronic PE have no
antecedent history of acute emboli.
We frequently detect pulmonary
hypertension even when less than 50%
of the vascular bed is occluded by
thrombus. This process may lead to an
inoperable situation.
The most common symptom associated with
thromboembolic pulmonary, hypertension,
as other of pulmonary hypertension, is
exertional dyspnea syncope or presyncope
is another common symptom in pulmonary
hypertension. Currently, pulmonary
angiography remains the gold standard
for diagnosis of chronic thromboembolic
pulmonary hypertension. Patients over age
40 undergo coronary arteriography and
other cardiac investigations as necessary.
Chronic anticoagulation represents the
main stay of medical regimen because
of the bronchial circulation, pulmonary
embolism, seldom results in tissue necrosis.
Pulmonary endarterectomy appears to be
permanently curative.
The severity of pulmonary hypertension at
the time of diagnosis inversely correlates
with duration of survival in this article
we report 1 case of successful pulmonary
thrombo endarterectomy (PTE), focusing
on the surgical technique and outcome
of the patient underwent PTE for chronic
thromboembolic pulmonary hypertension.
Cardiac surgery Department, shahid
Rajaee Heart Center, Tehran, Iran.