There are two important options in the surgical treatment of chronic pulmonary hypertension, namely thrombendarterectomy or, if there are no other alternatives, transplantation, which nowadays is almost always double-lung transplantation. Pulmonary thrombendarterectomy is indicated in patients who have a mean pulmonary artery pressure (PAPm) of 40 mm Hg or more, have proximal changes (types I - II) and are in NYHA functional class III - IV. An initial estimate of whether surgical intervention is reasonable can be obtained with spiral computed tomography and pulmonary angiography. Immediate postoperative death rate averages 10 %. In well selected patients operation improves hemodynamics, quality of life and long-term prognosis. Transplantation is indicated in the end-stage. But this therapeutic option is limited by the scarcity of lungs suitable as transplants.