Successful Surgical Intervention in Severe Chronic Thromboembolic Pulmonary Hypertension

A 69-year-old man, in whom extensive embolic obstruction of the pulmonary arteries had likely been present for ten years, and who exhibited marked pulmonary hypertension and compromise of right ventricular function, was submitted to thromboendarterectomy. The course after surgery included extensive hemorrhagic infiltration of the reperfused lung zones (predicted before operation), which required special management. Four months after surgery, reduction in pulmonary vascular resistance of almost 50 percent was demonstrated. The patient is improved and maintains normal activity more than two years after surgery. The patient demonstrates that, despite several negative features before operation, successful thromboendarterectomy is possible, if recent technical and conceptual advances are applied in a coordinated manner during all phases of management.