Chronic thromboembolic pulmonary hypertension - surgical treatment options and our experience

Background: Chronic thromboembolic pulmonary hypertension is an increasingly recognized cause of pulmonary hypertension. The prognosis of untreated patients is poor. The treatment of choice is the potentially curative pulmonary endarterectomy, which is feasible in more than half of the cases. The advances in operative techniques make pulmonary endarterectomy possible even in patients with very peripheral thromboemboli in the subsegmental arteries. Due to rarity of the disease it is advisable to perform the procedure in experienced specialized centers with high frequency of operations and thus low perioperative risk. Patients with persistent pulmonary hypertension after surgery and patients who have inoperable disease can be treated with vasodilators and remodulators of pulmonary vasculature, which improve prognosis to some extent. The final treatment option is lung transplantation. Conclusions: Patients with chronic trombo-embolic pulmonary hypertension have to be evaluated by a consultant surgeon with experience in pulmonary endarterectomy. In the last year two Slovenian patients were referred from our clinic to the University hospital in Vienna for pulmonary endarterectomy. The treatment was successful with good followup results.