Pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension

Chronic thromboembolic pulmonary hypertension (CTEPH) is a type of pulmonary hypertension caused by thromboembolic disease. It can affect patients of all age groups. Pulmonary endarterectomy allows surgical clearance of the pulmonary artery obstructive disease and can be curative in the majority of patients. Despite 40 years of experience, many controversies still remain (natural history, diagnosis, selection of the patient for surgery) and better definition of the preoperative risk is needed. The success of surgery depends on surgical experience, a complete clearance of segmental disease as well as the management in the intensive care unit. However, this disease remains under diagnosed in primary and secondary care and more awareness of this potentially treatable serious condition is needed. With a focus on current knowledge of this disease, this article intends to provide a theoretical background to facilitate this difficult but necessary first step, allowing more patients affected by CTEPH to benefit from a cure by pulmonary endarterectomy.