What is Pulmonary Endarterectomy

Pulmonary Endarterectomy (PEA) is a complicated surgical procedure that could be life-saving that is used in the treatment of chronic thromboembolic hypertension (CTEPH). It is the process of removing blood clots that are organized and scar tissue that has formed in the pulmonary arteries, which restores normal blood flow and decreasing the pressure of the lung.

Why Pulmonary Endarterectomy is Performed

Understanding of what is pulmonary endarterectomy

Pulmonary Endarterectomy is the most effective treatment for those suffering from chronic thromboembolic hypertension in the pulmonary arteries, an uncommon form of pulmonary hypertension that is caused by persistent blood clots within the lung. As time passes, the blood clots grow fibrosis and stop blood flow, leading to an increase in blood pressure within the pulmonary blood vessels.

This pressure increase puts pressure in the right heart side. This can lead to symptoms such as

• Breathing shortness
• Fatigue
• Chest pain
• The feeling of fainting or dizziness can be a cause.
• The legs are swelling or ankles

If left untreated, CTEPH could cause right heart failure, and eventually death. Pulmonary Endarterectomy may be the sole procedure that could provide an option to treat this disease.

Symptoms Indicating the Need for Pulmonary Endarterectomy

CTEPH patients often suffer from non-specific symptoms which can be similar to other lung or heart ailments. They include:

• Progression dyspnea (difficulty breathing) when you exert yourself
• General weakness and fatigue
• Heartbeats that are irregular or rapid
• Cyanosis (bluish lips or skin)
• Ankle swelling or abdomen

These signs typically appear gradually and are often not noticed at first. The disease advances the severity of pulmonary hypertension increases and the symptoms become more prominent and the quality of life diminished.

Causes of Chronic Thromboembolic Pulmonary Hypertension

CTEPH generally develops after several pulmonary embolisms (PEs)–blood blood clots that reach the lungs via the legs or from other areas within the human body. In some patients, the blood clots don’t dissolve completely and may cause inflammation and obstruction of the pulmonary arterial.

The risk factors and causes are:

• Previous episodes of embolisms in the lungs
• Genetic clotting disorders
• Autoimmune illnesses
• Inflammatory intestinal disease
• Removal of the spleen (splenectomy)
• The long-term use of central vein catheters

A small proportion of patients who suffer from a PE end up developing CTEPH however, if they do, prompt diagnosis and treatment is crucial.

Diagnosis Before Pulmonary Endarterectomy

The process of diagnosing CTEPH and determining the eligibility criteria for Pulmonary Endarterectomy requires a multi-modal strategy that incorporates:

 Ventilation-Perfusion (V/Q) Scan

It is the most accurate testing test that can detect the presence of CTEPH. It detects mismatched areas in which air can reach the lungs however blood doesn’t.

CT Pulmonary Angiography

The test gives complete information about the pulmonary arteries, and can help to identify clots.

Right Heart Catheterization

Monitors the pressure in the pulmonary artery and assesses the heart’s function.

Pulmonary Angiography

It is considered to be the gold standard test used to assess the degree of operability and severity of the disease.

A multidisciplinary team composed of cardiologists, pulmonologists and cardiothoracic surgeons generally evaluate every case to determine whether the patient is a suitable candidate for surgery.

The Pulmonary Endarterectomy Procedure

Pulmonary Endarterectomy is a special open heart surgery that is performed in specific centers that are experienced in treating CTEPH. The procedure is typically performed under general anesthesia and lasts approximately six to ten hours.

Surgical Steps:

1. The Heart and Lung Bypass Machine: The patient is put on cardiopulmonary bypass in order to maintain oxygenation and circulation.
2. “Deep Hypothermic Circulatory Assist” (DHCA) is when the body temperature is decreased to allow for a brief interruption in blood flow, while also effectively removing blood clots.
3. Clot Removal Surgery opens pulmonary arteries and removes with precision fibrous tissue and blood clots.
4. Reconstruction: Normal blood flow is restored and the lungs and heart are able to function normally again.

Recovery After Pulmonary Endarterectomy

The recovery process following PEA surgery is usually an inpatient stay of between 2 to 3 weeks, which includes the time spent in the ICU (ICU). Postoperative care centers on:

• Stabilizing lung and heart function
• Monitoring oxygen levels
• Prevention of infections and complications
• Rehabilitation for the respiratory tract and physiotherapy

Long-Term Outcomes:

• Increased capacity for exercise
• Life with a better quality
• The elimination or reduction of hypertension in the lungs
• Increased rates of survival

Studies have shown that more than 90% of the patients see significant improvement, with five-year survival rates of 85 percent when done at established centers.

Risks and Complications

Although Pulmonary Endarterectomy may be curative, it’s still a major operation that could carry risks:

• Bleeding
• Reperfusion lung injury
• Stroke
• Arrhythmias
• Residual hypertension in the pulmonary artery

But, in the hands of an experienced surgeon and with the proper postoperative treatment, the risk that serious issues will occur is very low.

Alternatives When PEA is Not Possible

Not all patients qualify for Pulmonary Endarterectomy. If you have CTEPH alternative treatments include:

• Balloon Pulmonary Angioplasty (BPA) is a minimally-invasive procedure that dilates the blocked arterial.
• Pulmonary Hypertension Medicines – Drugs such as riociguat are a good option to reduce symptoms and enhance fitness capacity.
• Therapy with oxygen and anticoagulants to treat symptoms and stop any further clots from forming.

Conclusion

Pulmonary Endarterectomy can be a lifesaving and potentially curative surgical option for patients suffering from chronic thromboembolic hypertension in the pulmonary artery. Although complex, it can provide hope and a better quality of life for those suffering from this debilitating condition.

If you or someone close to you is diagnosed with CTEPH you should consult an specialized pulmonary hypertension clinic to determine if Pulmonary Endarterectomy is the best choice for you.