Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: Technical challenges and controversies

Figures

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  Figure 1. Exposure of right (A) and left (B) pulmonary arteries by the inverted-T upper hemisternotomy.

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  Figure 2. Creation of dissection plan between intima and media in the right main pulmonary artery (A) and resected pulmonary endarterectomy specimens (B).

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  Figure 3. Sagittal (left) and coronal (right) computed tomography scan images showing hypertrophic bronchial collateral circulation in a chronic thromboembolic pulmonary hypertension patient.

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  Figure 4. Pulmonary angiography (right) showing complete right sided obstruction of the pulmonary artery with exception of an upper lobe branch. The resected endarterectomy specimen is shown on the left.

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  Figure 5. Bilateral pulmonary artery sarcoma successfully resected by pulmonary endarterectomy.

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  Figure 6. Restricted cubic spline analysis to express the relation between annual case volume of pulmonary endarterectomies of 51 centers (52 unique cohorts) and early mortality. Application of the elbow-method to this curve determines the case load that may define a high-volume center. The size of the dots corresponds to the variance of the data. If the variance is small (i.e., there is a high degree of certainty), dots are large, and relatively more weight is assigned to these findings.25