Surgery in chronic pulmonary embolism]

Chronic lung thromboembolism may develop after episodes of acute lung emboli. Instead of being resoluted, the thromboembolic material is incorporated into the walls of the lung arteries causing obstruction of the blood flow. Secondarily, pulmonary hypertension develops and patients experience increasing dyspnoea on exertion. In chronic pulmonary thromboembolism, drug therapy is of little benefit. Surgical thromboendarterectomy of lung arteries has emerged as an effective treatment for these very sick patients.This paper discusses our experience with seven patients who underwent pulmonary thromboendarterectomy during the five-year period 1995-99 at our institution. The preoperative and postoperative haemodynamic evaluation of all patients were similar.For five patients the working capacity was significantly improved, one had limited symptomatic effect, and one died perioperatively due to massive surgical bleeding.Pulmonary thromboendarterectomy may be indicated in selected patients with severe dyspnoea due to pulmonary hypertension secondary to chronic pulmonary thromboembolism.