CTEPH is an increasingly recognized complication of acute pulmonary embolism that can be effectively treated with pulmonary endarterectomy in patients with proximal disease.
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Heightens post-PE CTEPH surveillance; leaves open prospective trials on endarterectomy timing and selection.
hronic pulmonary thromboembolic disease is an important cause of severe pulmonary hypertension, and as such is associated with significant morbidity and mortality. The prognosis of this condition reflects the degree of associated right ventricular dysfunction, with predictable mortality related to the severity of the underlying pulmonary hypertension. In recent years the epidemiology of this condition has been revised considerably. Once considered a rare condition, chronic thromboembolic pulmonary hypertension (CTEPH) was recently documented to complicate 3.8% of acute pulmonary embolic events. Pulmonary endarterectomy (PEA) is the surgical procedure which removes the obstructing thromboembolic material, resulting in significant improvements (and in many cases normalisation) in right ventricular haemodynamics and function. This procedure requires a high degree of anaesthetic and surgical skill, coupled with assiduous preoperative evaluation of potential patients. Surgery is generally considered only in patients with proximal chronic thromboembolic disease as assessed by radiological investigations.
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McNeil et al. (2007) studied this question.
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