Pulmonary Thromboendarterectomy Surgery

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare form of pulmonary hypertension, with approximately 5000 new CTEPH cases per year in the United States. CTEPH can affect a patient’s health by causing a backup of oxygen-poor blood due to high pressure on the right side of the heart. The heart must use excess energy to push this oxygen-poor blood through the lungs, leading to a drop in oxygen levels. This condition results in abnormally high pressure in the small blood vessels of the lungs. These elevated pressure levels are caused by previous blood clots in the lung’s blood vessels that fail to dissolve. As a result, the blood vessels narrow and scar-like tissue develops. The narrower the blood vessels become, the higher the pressure in the heart. CTEPH symptoms can include chest pain or tightness, hemoptysis, cyanosis, dizziness, fatigue, heart palpitations, edema, or shortness of breath. There are various tests that can diagnose CTEPH such as lung ventilation-perfusion scan, pulmonary angiogram, or transthoracic echocardiograms. 

When one is diagnosed with CTEPH, the first treatment option is riociguat tablets. This pulmonary hypertension medication can bring symptom relief and is designed for patients who are physically unable to undergo procedures. A pulmonary thromboendarterectomy surgery (PTE) is a highly specialized surgery to treat CTEPH. PTE is typically an 8-10 hour procedure. The procedure for PTE is heavily detailed and precise. To begin, the surgical team will insert an endotracheal tube into your mouth and nose on one end and a ventilator on the other to allow for oxygen flow. Then, the surgeon will make an incision into your sternum to get in close proximity to your heart and lungs. After opening the chest, the surgeon will cool your body to about 64 degrees Fahrenheit. The body is cooled and blood circulation is temporarily stopped for surgeons to perform surgery precisely. The surgeon will also connect you to a cardiopulmonary bypass machine to act as your heart and lungs during the incision and procedure. Surgeons will then open the arteries blocked by clots and scar tissue. The surgeon will then warm your body to regular temperature and close the incision in your chest. Tubes will be left to drain fluid from your body. Following PTE, the patient is moved to the intensive care unit to remain in care overnight. The patient will receive a breathing test in 24 hours and with good rates, the ventilator will be removed. A patient will typically remain in care from 7-10 days. PTE has had a high rate of well outcomes and improves the quality of life for individuals with CTEPH.

Written By Urvi Vora at Incisionary

APA References

PHA, A. (2022, December 8). PTE Surgery. Pulmonary Hypertension Association. https://phassociation.org/about-cteph/pte-surgery/

Pulmonary endarterectomy | PHA. (2020). PHA. https://www.phauk.org/about-ph-2/treatment-for-pulmonary-hypertension/surgical-options/pulmonary-endarterectomy/

Pulmonary Endarterectomy Surgery India, India Pulmonary Endarterectomy. (2025). Indiahospitaltour.com. https://www.indiahospitaltour.com/vascular/pulmonary-endarterectomy-surgery-india.html

Pulmonary Thromboendarterectomy (PTE). (n.d.-a). UC San Diego Health. https://health.ucsd.edu/care/heart-vascular/pulmonary-hypertension/pte/

Pulmonary Thromboendarterectomy (PTE). (n.d.-b). Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/21024-pulmonary-thromboendarterectomy-surgery