SURGICAL-TREATMENT OF THROMBOEMBOLIC PULM ONARY-HYPERTENSION

Non-resolved chronic pulmonary thromboembolism is a frequent cause of pulmonary hypertension. In long-standing disease hypertension is progr essive due to intimal and medial changes in the perfused vessels. Non- resolution of thromboemboli is often associated with underlying coagul opathies; the presence of a lupus anticoagulant may pose a significant problem in the peri-operative management of these patients. Pulmonary thrombendarterectomy presents an efficient option of treatment which is feasible in the majority of patients. By means of pulmonary angiogr aphy and computed tomography operability is verified by the often diff icult recognition of thromboembolic changes in the central pulmonary a rteries. Patients with solely peripheral thromboembolic changes or pri mary pulmonary hypertension must be excluded. In presence of significa nt exertional dyspnea and/or pulmonary pressure elevation surgery is i ndicated. Mortality is high and mainly related to unrelieved pulmonary hypertension or pulmonary complications; pulmonary reperfusion edema, respiratory failure or pneumonia and sepsis. In all survivors the red uction of pulmonary hypertension is highly significant and persistent. Thromboembolic pulmonary hypertension may be treated curatively in mo st patients by thrombendarterectomy. Correct selection of surgical can didates is mandatory, and the patients should preferably be diagnosed and undergo surgery in an early stage of their disease.