Successful Surgical Intervention in Severe Chronic Thromboembolic Pulmonary Hypertension

Chronic Thromboembolic Pulmonary Hypertension: Effects of Pulmonary Endarterectomy

“…The current understanding is that a hemodynamically significant persistent obstruction of the pulmonary arteries may result in an elevated pulmonary artery pressure and high shear stress in areas which are spared from occlusion; this in combination with a concomitant inflammation, and an imbalance of vasoactive mediators may result in the vascular remodelling that is observed in these www.intechopen.com patients (Bauer et al, 2002;Humbert et al, 2004Humbert et al, 2004Reesink et al, 2006;Hoeper et al, 2004;Lang, 2010). Histopathologic changes in the microvasculature, similar to those demonstrated in other forms of pulmonary arterial hypertension (PAH), were observed in lung biopsy specimens from CTEPH patients (Moser et al, 1973). The development of this slowly progressive secondary arteriopathy in the non-obstructed precapillary pulmonary vessels is likely the cause of the progression of disease that can be observed in CTEPH patients (Fedullo et al, 2011;Hoeper et al, 2006;Lang, 2010).…”

Pulmonary Hypertension

“…A look at his published reports attests to the success of the procedure and growth of the program. In 1965, Moser reported a single successful thromboendarterectomy with 30-month followup, and a second report of a single success in 1973 (40,41). By 1983, he was able to report survival of 13 of 15 operated cases with marked improvement in functional status (42).…”

Acute Pulmonary Thromboembolism

“…At the University of California, San Diego, Medical Center, the operation has been performed in Ͼ1000 patients since 1970. [25][26][27][28][29] Considering their deteriorated quality of life and hemodynamic compromise, patient candidates have readily accepted the mortality risk of 5% to 10% for undergoing the operation. As with many surgical procedures, a comprehensive preoperative assessment of the pathoanatomy and pathophysiology of the disease process and associated conditions is crucial to ultimate surgical success.…”