Pulmonary thromboendarterectomy: Difference between revisions

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'''Pulmonary Thromboendarterectomy''' is a surgical procedure that is performed to remove organized clotted blood (thrombi) from the pulmonary arteries. This procedure is typically performed on patients who have been diagnosed with [[Chronic Thromboembolic Pulmonary Hypertension]] (CTEPH).
== Pulmonary Thromboendarterectomy ==


== Overview ==
[[File:PEA_specimen.tif|thumb|right|A specimen from a pulmonary thromboendarterectomy procedure.]]


[[Pulmonary Thromboendarterectomy]] (PTE) is a complex surgical procedure that requires a highly skilled surgical team. The procedure involves the removal of thrombi from the pulmonary arteries, which can improve blood flow to the lungs and reduce pulmonary hypertension.
Pulmonary thromboendarterectomy (PTE), also known as pulmonary endarterectomy, is a surgical procedure performed to remove organized clotted blood (thrombus) from the pulmonary arteries. This procedure is primarily used to treat chronic thromboembolic pulmonary hypertension (CTEPH), a condition where blood clots obstruct the pulmonary arteries, leading to increased blood pressure in the lungs and right heart failure.


== Indications ==
== Indications ==


PTE is indicated for patients with [[Chronic Thromboembolic Pulmonary Hypertension]] (CTEPH) who have not responded to medical therapy. CTEPH is a condition characterized by the presence of chronic, organized thrombi in the pulmonary arteries that obstruct blood flow and lead to pulmonary hypertension.
Pulmonary thromboendarterectomy is indicated for patients diagnosed with CTEPH who have persistent pulmonary hypertension despite anticoagulation therapy. The procedure is considered when the thrombi are surgically accessible, and the patient is deemed a suitable surgical candidate based on their overall health and the severity of their condition.


== Procedure ==
== Procedure ==


During a PTE, the patient is placed on [[cardiopulmonary bypass]] and the body is cooled to reduce metabolic demand. The surgeon then opens the pulmonary arteries and removes the thrombi. The procedure is performed under deep hypothermic circulatory arrest to protect the brain and other vital organs.
The surgery is performed under general anesthesia and requires cardiopulmonary bypass. The surgeon makes an incision in the chest to access the heart and lungs. The pulmonary arteries are opened, and the organized thrombi are carefully removed. This process restores normal blood flow and reduces pulmonary artery pressure.


== Risks and Complications ==
The procedure is complex and requires a specialized surgical team with experience in managing CTEPH. Postoperative care is critical, and patients typically require monitoring in an intensive care unit.


As with any major surgery, PTE carries risks and potential complications. These may include bleeding, infection, stroke, and death. Specific to PTE, there is a risk of reperfusion injury, which can lead to acute respiratory distress syndrome (ARDS).
== Complications ==


== Prognosis ==
Complications from pulmonary thromboendarterectomy can include reperfusion pulmonary edema, bleeding, and infection. Long-term complications may involve residual pulmonary hypertension if not all thrombi are removed or if there is underlying small vessel disease.


The prognosis following PTE is generally good, with many patients experiencing significant improvement in symptoms and quality of life. However, the success of the procedure depends on a variety of factors, including the extent of the disease and the patient's overall health.
== Outcomes ==


== See Also ==
When successful, pulmonary thromboendarterectomy can significantly improve symptoms, exercise capacity, and quality of life for patients with CTEPH. It can also reduce or normalize pulmonary artery pressures, thereby decreasing the strain on the right side of the heart.


* [[Chronic Thromboembolic Pulmonary Hypertension]]
== Related pages ==
* [[Pulmonary Hypertension]]
* [[Cardiopulmonary Bypass]]
* [[Acute Respiratory Distress Syndrome]]


[[Category:Medical Procedures]]
* [[Chronic thromboembolic pulmonary hypertension]]
[[Category:Cardiology]]
* [[Pulmonary hypertension]]
[[Category:Pulmonology]]
* [[Cardiopulmonary bypass]]
* [[Right heart failure]]


{{stub}}
{{Surgery}}
{{Cardiology}}
 
[[Category:Cardiothoracic surgery]]
[[Category:Pulmonary hypertension]]

Latest revision as of 16:26, 16 February 2025

Pulmonary Thromboendarterectomy[edit]

A specimen from a pulmonary thromboendarterectomy procedure.

Pulmonary thromboendarterectomy (PTE), also known as pulmonary endarterectomy, is a surgical procedure performed to remove organized clotted blood (thrombus) from the pulmonary arteries. This procedure is primarily used to treat chronic thromboembolic pulmonary hypertension (CTEPH), a condition where blood clots obstruct the pulmonary arteries, leading to increased blood pressure in the lungs and right heart failure.

Indications[edit]

Pulmonary thromboendarterectomy is indicated for patients diagnosed with CTEPH who have persistent pulmonary hypertension despite anticoagulation therapy. The procedure is considered when the thrombi are surgically accessible, and the patient is deemed a suitable surgical candidate based on their overall health and the severity of their condition.

Procedure[edit]

The surgery is performed under general anesthesia and requires cardiopulmonary bypass. The surgeon makes an incision in the chest to access the heart and lungs. The pulmonary arteries are opened, and the organized thrombi are carefully removed. This process restores normal blood flow and reduces pulmonary artery pressure.

The procedure is complex and requires a specialized surgical team with experience in managing CTEPH. Postoperative care is critical, and patients typically require monitoring in an intensive care unit.

Complications[edit]

Complications from pulmonary thromboendarterectomy can include reperfusion pulmonary edema, bleeding, and infection. Long-term complications may involve residual pulmonary hypertension if not all thrombi are removed or if there is underlying small vessel disease.

Outcomes[edit]

When successful, pulmonary thromboendarterectomy can significantly improve symptoms, exercise capacity, and quality of life for patients with CTEPH. It can also reduce or normalize pulmonary artery pressures, thereby decreasing the strain on the right side of the heart.

Related pages[edit]


Surgery
subspecialties
General procedures




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