Chronic Thromboembolic Pulmonary Hypertension: Surgical Treatment

Over the past quarter century, the recognition, evaluation, and management of patients with chronic thromboembolic pulmonary hypertension (CTEPH) have experienced considerable forward strides. This has been accompanied by a better understanding of the risk factors associated with the development of this disorder and an appreciation that CTEPH is more prevalent than previously acknowledged. Investigative efforts have also begun to elucidate the mechanisms by which acute thrombi organize within the pulmonary vascular bed and how this may initiate the pulmonary vascular changes seen in this disorder. These efforts have become “global endeavours” (Jenkins et al. (Eur Respir J 41:735–742, 2013), expanding the ability to care for a greater number of patients afflicted with this previously fatal disorder. However, many challenges remain. The selection criteria for patients who might be considered candidates for thromboendarterectomy, the therapy which offers the greatest chance for a cure, continues to vary considerably. Though the availability of pulmonary hypertensive medical therapy has expanded over the past decade, the patients with CTEPH who would be best treated with these medications remain incompletely defined. And as percutaneous pulmonary angioplasty has resurfaced as a therapeutic option, its role in the care and management of CTEPH patients has to be more clearly established. This chapter provides an overview of the most recent information on the natural history, evaluation, and management of patients with chronic thromboembolic disease.

Duke Scholars

Author William R. Auger Medicine, Pulmonary, Allergy, and Critical Care Medicine