Pulmonary thromboendarterectomy and cavotomy of calcified superior vena cava

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: 46-year-old female patient with chronic thromboembolic pulmonary hypertension, superior vena cava calcification, antiphospholipid syndrome, systemic lupus erythematosus, and history of deep vein thrombosis and pulmonary embolism (n=1). Intervention: Pulmonary thromboendarterectomy and cavotomy with endarterectomy of calcified superior vena cava. Primary outcome: Postoperative cardiac function and pulmonary artery pressure (EF increased from 58% to 60%, sPAP decreased from 24 mmHg to 26 mmHg postoperatively).

Q: What does this research mean for the field?

Pulmonary thromboendarterectomy combined with cavotomy is a viable and successful surgical intervention for managing chronic thromboembolic pulmonary hypertension concurrent with rare superior vena cava calcification. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Osman Fehmi Beyazal; Zeki Temiztürk; Mahmud Çelenkoğlu; Mehmed Yanartaş

doi:10.4274/tjtcs.2025.28744

February 13, 2026Turkish Journal of Thoracic and Cardiovascular SurgeryOpen Access

Pulmonary thromboendarterectomy and cavotomy of calcified superior vena cava

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Key result

Combined PTE and SVC cavotomy enables complication-free discharge in a CTEPH patient with SVC calcification.

EF increased from 58% to 60%, sPAP decreased from 24 mmHg to 26 mmHg postoperatively
n=1

Why the study?

Superior vena cava calcification is very rare in adults but can lead to life-threatening complications such as pulmonary embolism.

Key Points

To describe the surgical management and pathological findings of concurrent pulmonary thromboendarterectomy and cavotomy in an adult presenting with chronic thromboembolic pulmonary hypertension and severe superior vena cava calcification.
A 46-year-old female with antiphospholipid syndrome and chronic thromboembolic pulmonary hypertension was evaluated using computed tomography angiography, ventilation-perfusion scintigraphy, and right heart catheterization.
The patient underwent bilateral pulmonary thromboendarterectomy during 15 minutes of total circulatory arrest and 244 minutes of cardiopulmonary bypass, combined with superior vena cava endarterectomy, cavotomy, and bovine pericardial patch repair.
Postoperative echocardiography at one week demonstrated an ejection fraction of 60% and a systolic pulmonary artery pressure of 26 mmHg, improved from a preoperative mean pulmonary artery pressure of 24 mmHg.
The patient was discharged after 11 days with no postoperative complications and remained event-free during a 2-month follow-up period on warfarin anticoagulation.
Pathological examination of surgical specimens confirmed degenerated fibroblastic tissue and dense dystrophic calcification within both pulmonary arteries and the superior vena cava.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 46-year-old female patient with shortness of breath, chronic thromboembolic pulmonary hypertension (CTEPH), and widespread calcification in the superior vena cava (SVC). History of hypertension, deep vein thrombosis, pulmonary embolism, antiphospholipid syndrome, and systemic lupus erythematosus.

I

Intervention

Pulmonary thromboendarterectomy (PTE) and endarterectomy with cavotomy of the superior vena cava (SVC) under total circulatory arrest.

O

Outcome

Surgical success and postoperative recovery

Main Result

Effect estimate: EF increased from 58% to 60%, sPAP decreased from 24 mmHg to 26 mmHg postoperatively

Absolute Event Rate: 60% vs 58%

Limitations

Single patient case report limiting generalizability.
No control or comparator group.
Short postoperative follow-up duration of 2 months.
Lack of quantitative statistical analysis due to single case nature.

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Implication

Surgical treatment with pulmonary thromboendarterectomy and cavotomy can be successfully performed for rare cases of superior vena cava calcification concurrent with CTEPH.

Abstract

Superior vena cava (SVC) calcification is very rare in adults, however it can lead to life-threatening complications such as pulmonary embolism. A 46-year-old female patient presented with complaints of shortness of breath. Computed tomography revealed widespread calcification in the SVC in addition to chronic thromboembolic pulmonary hypertension (CTEPH). In this case report, we present a patient who underwent pulmonary thromboendarterectomy due to CTEPH and endarterectomy and cavotomy due to calcification in the SVC.

Discussion

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Cite This Study

Beyazal et al. (2026) conducted a case report in 46-year-old female patient with chronic thromboembolic pulmonary hypertension, superior vena cava calcification, antiphospholipid syndrome, systemic lupus erythematosus, and history of deep vein thrombosis and pulmonary embolism (n=1). Pulmonary thromboendarterectomy and cavotomy with endarterectomy of calcified superior vena cava was evaluated on Postoperative cardiac function and pulmonary artery pressure (EF increased from 58% to 60%, sPAP decreased from 24 mmHg to 26 mmHg postoperatively). Pulmonary thromboendarterectomy and cavotomy of calcified superior vena cava was successfully performed, with EF improving from 58% to 60% and sPAP maintained at 26 mmHg, leading to complication-free discharge in a 46-year-old female with CTEPH and SVC calcification.

synapsesocial.com/papers/6992b3e59b75e639e9b08a85 https://doi.org/10.4274/tjtcs.2025.28744

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Pulmonary thromboendarterectomy and cavotomy of calcified superior vena cava

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Pulmonary thromboendarterectomy and cavotomy of calcified superior vena cava

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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