Chronic Pulmonary Thromboembolic Disease is a condition in which a blood clot to the lungs, otherwise known as a pulmonary embolism, causes the blood vessels in the lungs to become diseased. Due to the constriction in the blood vessels, chronic pulmonary thromboembolic disease affects the pulmonary vessels and may lead to pulmonary hypertension.

Why would surgery be needed for Pulmonary Thromboembolic Disease?

Because chronic pulmonary thromboembolic disease leads to pulmonary hypertension, symptoms such as enlarged main pulmonary arteries, atherosclerotic calcification, tortuous vessels, right ventricular enlargement and hypertrophy, as well as signs of enlargement of bronchial and nonbronchial systemic arteries are common. Therefore individuals with such symptoms may require further diagnostic testing to find the root cause of such symptoms in order to diagnose and treat the patient accurately.

Dr Scott may use a CT scan to diagnose chronic pulmonary thromboembolic disease better and evaluate the severity of the obstruction in the pulmonary blood vessels. The CT scan will aid your cardiothoracic surgeon in evaluating the blood vessels. Whether the vascular obstruction is complete or partial, or whether eccentric thrombus, calcified thrombus, bands, webs, post-stenotic dilatation are present, a surgery known as pulmonary thromboendarterectomy surgery, may be done by your cardiothoracic surgeon as a treatment for this condition. This surgery will be able to improve blood flow in the lungs, prevent the right side of the heart from weakening and remove clots from the vessels and thus the pressure in your lungs.

How is this procedure done?

Chronic thromboembolic disease may be treated by prescribing blood thinners and performing a surgery called thromboendarterectomy, in which the obstructions in the pulmonary arteries are cleared.

Under general anaesthesia, an incision in the chest is made so that Dr Scott may access the chest cavity. You will be connected to a heart-lung bypass machine which will take over the duties of the heart and lungs in supplying the body with oxygenated blood. By doing this, your cardiothoracic surgeon may see the blood clots in the arteries better. The heart-lung bypass machine is then stopped temporarily, to make it easier for your surgeon to remove the clots from the arteries. Thereafter the incision is closed, and you are moved to ICU for the next 2-4 days.

What can I expect after surgery?

Waking up from surgery, you can expect a chest tube to be placed in your chest to drain any blood or fluid that may build up in the chest. You will also have a breathing tube placed to aid the lungs and a temporary pacemaker for your heart. You should have a catheter placed for urine for the next few days before you can get up and move around. You will be kept in the ICU for close observation of your heart, blood flow and fluid drainage for about 2-4 days. On a daily basis, you will receive oxygen therapy and be given compression stockings to wear on your legs as well. You will be moved from ICU to your hospital room where you will be advised to stay for a further 7-10 days before you may go home.

Your cardiothoracic surgeon will advise you on how to care for your incisions and how to treat the symptoms after surgery. Symptoms of swelling, muscle pain in the upper back and shoulders, fatigue, sleeping and appetite problems, constipation and chest pain near the chest bone are all normal after repair or replacement surgery.

It may take anything from 6-12 weeks for a full recovery, and Dr Scott will be able to tell you when you may begin physical activity. You will be instructed to walk regularly and slowly increase your activity, as well as how to do breathing exercises to aid recovery. Patients are usually able to return to work at 6 weeks post-operation depending on the physical demand of their type of work.