FULL WORKING CAPACITY OR THREATENED RETIREMENT - THROMBENDARTERECTOMYIN A CASE OF CHRONIC THROMBOEMBOLIC PULMONARY-HYPERTENSION

History and clinical findings: A 56-year-old man in marked right heart failure (stage III-IV of the New York Heart Association classificatio n) and severe pulmonary hypertension was admitted to a rehabilitation clinic for therapeutic and social-medical assessment. On physical exam ination the important features were markedly distended neck veins, tac hycardia at rest (90/min), a loud 2(nd) pulmonary sound and dyspnea. I nvestigations and diagnosis: Non-invasive tests (ECC, echocardiography , abdominal ultrasound and lung functions) confirmed right heart failu re; invasively obtained haemodynamic data indicated its severity. Sele ctive pulmonary angiography defined the embolisation to be central and bilateral. Treatment and course: As intensive drug treatment and phys iotherapy had failed to achieve significant improvement, operative rem oval of the bilateral central and some segmental pulmonary thrombi was performed and an inferior vena caval filtre inserted. Immediately aft er operation the markedly elevated right-heart and pulmonary artery pr essures fell markedly and there was dramatic improvement in the patien t's general condition and in his physical capacity. Angiography demons trated largely normal pulmonary perfusion. Instead of the anticipated retirement, the patient was discharged on anticoagulants, in the expec tation of a return to full-time work. Conclusion: With pulmonary throm bendarterectomy severe chronic thromboembolic pulmonary hypertension m ay well be treated.