A successful case of pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension with a thrombus in the right ventricle

Abstract

Chronic thromboembolism is a frequent cause of progressive hypertension and carries a poor prognosis. Medical treatment is not effective and surgery provides the only potential for a cure at present. We herein report a successful case of thromboendarterectomy treated via a median sternotomy with intermittent circulatory arrest. A 43-year-old man was admitted to our hospital complaining of progressive dyspnea, edema of the lower extremities, and a fever with an unknown origin. A subsequent definitive evaluation showed him to be suffering from surgically accessible chronic thromboembolic pulmonary hypertension with a thrombus in the right ventricle. He underwent a pulmonary thromboendarterectomy and thrombectomy via a median sternotomy with intermittent circulatory arrest on November 24, 1994. Postoperatively he showed a marked improvement in his hemodynamic status and blood gas analysis. He has also returned to work with no trouble. Deep vein thrombosis appeared to be the pathogenesis of this case, but we could not find the origin of his unknown fever. He is currently being controlled by treatment with methylprednisolone as before.

Pulmonary thromboendarterectomy after treatment with treprostenil in a chronic thromboembolic pulmonary hypertension patient: a case report

“…PTE is the definitive treatment for chronic pulmonary hypertension resulting from thromboembolic disease 5,6,9. Pulmonary thromboendarterectomy can markedly reduce and even normalize pulmonary hemodynamics.…”

“…Treatment of CTEPH often requires a multidisciplinary approach and may involve surgery, medical treatment, or both 5,6. Vascular disobliteration by pulmonary endarterectomy (PTE) is the preferred treatment for patients with CTEPH,7,8 but not all patients are eligible for surgery 9.…”

Surgical Treatment for Chronic Pulmonary Thromboembolism Under Cardiopulmonary Bypass with Selective Cerebral Perfusion

“…2,3 The reason for using intermittent circulatory arrest is to obtain good showing improvement in the blood flow in the right lobe visibility without back-bleeding from the bronchial arteries. [5][6][7][8][9] The problem of chronic pulmonary thromboembolism has recently received a great deal of attention in Japan, and various surgical treatments have been reported to be effective. According to these reports, both a thoracotomy approach and a median sternotomy approach have been adopted.…”