A Lifesaving Surgical Option for Chronic Thromboembolic Pulmonary Hypertension (CTEPH)
Pulmonary hypertension (PH) is a serious condition in which high blood pressure affects the arteries in the lungs. Among its various forms, one of the most treatable but often underdiagnosed is Chronic Thromboembolic Pulmonary Hypertension (CTEPH).
While many types of pulmonary hypertension require lifelong medical therapy, CTEPH offers a potential surgical cure: a procedure known as pulmonary endarterectomy (PEA).
In this article, we’ll explore what PEA is, how it works, who qualifies for the surgery, and why it can be life-saving for selected patients with CTEPH.
What Is CTEPH?
Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is a rare form of pulmonary hypertension caused by unresolved blood clots in the pulmonary arteries. These clots turn into scar-like tissue that blocks or narrows the vessels, leading to:
- Increased pressure in the lung arteries
- Reduced oxygen exchange
- Strain on the right side of the heart
- Progressive symptoms such as shortness of breath and fatigue
Unlike other types of PH, CTEPH is potentially curable through surgery if diagnosed early and correctly.
What Is Pulmonary Endarterectomy (PEA)?
Pulmonary Endarterectomy (PEA) is a complex surgical procedure that removes organized blood clots and scar tissue from the pulmonary arteries. It’s currently the only definitive treatment that can cure CTEPH in eligible patients.
The surgery is performed under general anesthesia and cardiopulmonary bypass, and it involves:
- Temporarily stopping the heart and cooling the body
- Making precise incisions in the pulmonary arteries
- Removing chronic thromboembolic material from deep within the lung vessels
- Restoring normal blood flow and reducing pressure in the lungs
The result: dramatic improvement in symptoms, right heart function, and overall quality of life.
Who Is a Candidate for PEA?
Not every patient with pulmonary hypertension is eligible for PEA. The procedure is specifically for those with confirmed CTEPH, and certain criteria must be met:
Ideal Candidates:
- Diagnosed with CTEPH confirmed via imaging (V/Q scan, CT pulmonary angiography)
- Obstruction is located in surgically accessible pulmonary arteries
- Reasonable heart and lung function to tolerate major surgery
- Symptoms such as shortness of breath, fatigue, or reduced exercise tolerance
Patients are carefully evaluated by a multidisciplinary team including pulmonologists, cardiologists, and cardiovascular surgeons to determine if PEA is appropriate.
What Are the Benefits of PEA?
PEA is considered the gold standard treatment for eligible CTEPH patients. Its benefits include:
- Curative potential: Unlike medication, surgery can remove the root cause of the disease
- Improved survival rates: 5-year survival after successful PEA exceeds 90% in many centers
- Symptom relief: Most patients experience significant improvement in breathing, stamina, and daily functioning
- Reduced need for lifelong medications in many cases
At Erdem Hospital, PEA is performed by experienced cardiothoracic surgeons using internationally recognized protocols and postoperative care standards.
What Are the Risks?
As with any major surgery, PEA carries potential risks, including:
- Bleeding or infection
- Reperfusion lung injury (temporary fluid leakage in lungs after restored blood flow)
- Arrhythmias or heart rhythm issues
- Residual pulmonary hypertension (in about 30% of patients, manageable with medication)
However, in specialized centers, the mortality rate for PEA is typically under 5%, especially when performed by experienced teams.
What If Surgery Is Not an Option?
If the disease is too distal or the patient is not a surgical candidate, alternative treatments may include:
- Pulmonary balloon angioplasty (BPA) – catheter-based technique to widen narrowed vessels
- Pulmonary vasodilator medications, such as riociguat
- Oxygen therapy and rehabilitation programs
While not curative, these options can still improve quality of life and symptoms.
Frequently Asked Questions (FAQ)
1. How do I know if I have CTEPH?
CTEPH is suspected in patients with a history of blood clots and ongoing shortness of breath, even after anticoagulation. Diagnosis is confirmed through V/Q scan, right heart catheterization, and CT angiography.
2. Is pulmonary endarterectomy a risky surgery?
It is a highly specialized but safe surgery when performed in expert centers. Risks are minimized through careful patient selection and surgical experience.
3. Will I still need medication after PEA?
In many cases, no. If the surgery is successful and completely clears the obstruction, patients may discontinue pulmonary hypertension medications. Some may still require anticoagulants to prevent future clots.
4. How long is recovery after surgery?
Most patients remain in the hospital for 7–14 days, including time in the intensive care unit. Full recovery can take several weeks to months, depending on age and overall health.
5. Can PEA cure all types of pulmonary hypertension?
No. PEA is only curative for CTEPH, not other forms like pulmonary arterial hypertension (PAH) or PH due to heart/lung disease.
Reclaiming Breath and Life
Pulmonary hypertension doesn’t always have to be a lifelong condition. For those diagnosed with CTEPH, pulmonary endarterectomy offers a real chance at cure, restoring not just blood flow, but quality of life and independence.
At Erdem Hospital, our dedicated cardiovascular surgery and pulmonary hypertension teams are proud to offer advanced diagnostics, surgical expertise, and postoperative care tailored to each patient’s needs. If you or a loved one is struggling with unexplained shortness of breath or chronic clots, don’t wait for a second opinion that could save your life.