Pulmonary Endarterectomy (PEA) is a complicated but potentially life-saving surgery intended for the treatment of Chronic Thromboembolic Pulmonary Hypertension (CTEPH). This rare, but severe form of pulmonary hypertension result from blood clots that have a tendency to block the pulmonary arteries. This causes more tension on the left side of the heart. It could eventually lead to heart failure if not treated.

In contrast to other forms of pulmonary hypertension CTEPH can be treated and the Pulmonary Endarterectomy is considered to be the best treatment. In this specialized procedure the surgeons eliminate blood clots, scar-like tissue and blood clots in the arteries of the pulmonary system. This is done with the intention of increasing blood flow as well as reducing the pressure of the pulmonary artery.

With the advancement of surgical techniques as well as post-operative care patients with CTEPH have the chance to return the normal function of their lungs and dramatically enhance their quality of life. Let’s look at why this procedure is required and why it a crucial procedure.

Why is Pulmonary Endarterectomy Needed?

Pulmonary Endarterectomy is essential for patients diagnosed with CTEPH, which is a condition that manifests when blood clots that form in the lungs don’t dissolve, but instead develop into fibrosis, adhering to the wall of the pulmonary blood vessels. The chronic blockage can disrupt normal blood flow, increasing the pressure in the circulation of the pulmonary artery.

As time passes, CTEPH leads to:

Breathing shortness
Fatigue
Chest pain
Affright or dizziness
Right heart failure

Although medications can help manage symptoms, they aren’t able to eliminate the clots. Pulmonary Endarterectomy remains the sole curative procedure that eliminates the obstruction, thus reducing the stress to the heart, and improving blood flow.

A surgical intervention is generally recommended in the following situations:

It is possible to remove blood clots surgically
The patient’s health is stable enough to undergo major surgery.
None of the other lung conditions hinder the effectiveness of the surgery

If not treated, CTEPH can be fatal. Thus an early diagnosis and prompt surgical treatment are essential for life and recovery.

Symptoms for Pulmonary Endarterectomy

Recognizing the signs and symptoms of Pulmonary Endarterectomy typically begins by recognizing the symptoms of CTEPH. Because early symptoms can mimic other ailments The diagnosis is often delayed. Pay attention to the following warning symptoms:

Breathlessness that is persistent, particularly during physical exercise
The feeling of fatigue and fatigue is a general one. of weakness
The chest may be painful or uncomfortable.
The legs are swelling and the ankles
Heart palpitations or irregular heartbeats
The dizziness or fainting sensation is more common during exercise
Cyanosis (bluish hue around the lips and around the fingertips because of the low oxygen levels)

If symptoms continue to be persist despite standard treatment options for asthma or pulmonary embolism further testing for CTEPH must be performed.

Causes for Pulmonary Endarterectomy

The main reason for requiring an Pulmonary Endarterectomy is the chronic Thromboembolic Pulmonary Hypertension (CTEPH). The cause of this condition is:

Unsolved pulmonary embolisms, blood clots which travel to lung and do not dissolve over time.
Hypercoagulable states are conditions that make blood more likely to clot (e.g. antiphospholipid syndrome and protein C/S deficiencies)
A history of Deep Vein Thrombosis (DVT)
Cancer, splenectomy or infections such as osteomyelitis
A genetic predisposition can cause abnormal blood clotting

In many instances the cause of the embolism that started it is unknown. The majority of patients with an embolism in the lungs develops CTEPH however, it is estimated that 3-4 percent of patients do, necessitating a pulmonary endarterectomy.

Diagnosis for Pulmonary Endarterectomy

Finding out if you have CTEPH is the very first and most crucial step prior to contemplating a the possibility of a Pulmonary Endarterectomy. A thorough evaluation usually comprises:

Ventilation-Perfusion (V/Q) Scan :- The non-invasive scan can detect different regions in the lungs – areas which are ventilated, but not being perfused because of obstruction. It is the first line screening instrument for CTEPH.
CT Pulmonary Angiography :- The site provides detailed pictures of pulmonary arteries, showing chronic clots and webs.
Right Heart Catheterization :- The test measures blood pressures of the right and pulmonary arteries to determine if there is a problem with pulmonary hypertension and determine the operability.
Pulmonary Angiography :- An in-depth, yet definitive test to determine the exact location of obstructions within the pulmonary arteries.
Echocardiogram :- Assesses the functions that the right heart side performs, and determines if the heart is expanding or strain caused by hypertension pulmonary. A timely and precise diagnosis of Pulmonary Endarterectomy is crucial in identifying patients for this potentially curative treatment.

Treatment for Pulmonary Endarterectomy

The most effective treatment for The only treatment for Endarterectomy is the procedure itself. Here’s an overview of what patients can expect

Pre-Surgical Preparation

Complete pulmonary and cardiac evaluations
Anticoagulation therapy and rehabilitation for the lungs.
Evaluation by a multidisciplinary group comprised of cardiologists, pulmonologists and the thoracic surgeons

The Surgical Procedure

Performed under general anesthesia, PEA involves:

The chest can be opened by the median the sternotomy
Using cardiopulmonary bypass (heart-lung machine)
Inducing deep hypothermic cardiac blockage (cooling your body down to 20 degrees Celsius) to remove the clots
Removing fibrotic material off the branches of the pulmonary artery

The procedure can take between 6 and 10 hours, based on the degree of clot burden.

Post-Surgery Recovery

ICU is a place to monitor and assistance
Therapy with oxygen and medication to reduce the pulmonary pressure
Anticoagulation for long-term use (blood thinners)
Rehabilitation of the pulmonary system

Prognosis

If it is PEA is successful PEA is able to:

Normalize pulmonary arterial pressure
Increase the oxygenation
Improve fitness capacity
Significantly increase the life expectancy of people

Over 90% of patients who are suitable exhibit dramatic improvement in their symptoms and health after surgery.

Conclusion

Pulmonary Endarterectomy goes beyond an operating procedure, it’s an emergency treatment for those suffering from CTEPH. It has the potential to completely treat this progressively advancing and life-threatening disease, PEA offers hope, healing, and a new feeling of wellbeing.

If you suffer with chronic fatigue, breathlessness or persistent symptoms of pulmonary hypertension following pulmonary embolism, seeking an evaluation for CTEPH may be life-saving. A timely diagnosis, a proper surgical plan, and skilled care can make all the difference.

If you or someone close to you suffers from CTEPH seek out an expert in pulmonary hypertension, or cardiothoracic surgeon skilled in pulmonary endarterectomy. They can help you determine the most effective treatment options.