Pulmonary thromboendarterectomy for pulmonary hypertension

Chronic thromboembolic pulmonary hypertension is a term that has been proposed by Dr. Kenneth Moser to describe a progressively debilitating process that occasionally follows venous thrombosis and pulmonary embolism. In the past, the disease was dramatically underdiagnosed for several reasons: 1) the initial event--deep vein thrombosis or pulmonary embolism--is usually clinically silent; 2) there is a subsequent asymptomatic "honeymoon period" in most patients; 3) there is no clinical description of chronic thromboembolic pulmonary hypertension in most textbooks of medicine and surgery; and 4) until recently, surgical therapy could be performed by only a few surgeons, and with a prohibitive operative mortality. Intensive efforts by physicians at the University of California, San Diego have led to increased recognition of the disease, a better understanding of its pathophysiology, and development of a curative procedure with an acceptable operative mortality. Chronic thromboembolic pulmonary hypertension is truly the "aortic stenosis" of the pulmonary circulation, and the clinical improvement after pulmonary thromboendarterectomy is even more dramatic than that seen after aortic valve replacement.