[Surgical treatment for chronic pulmonary thromboembolism]

Chronic pulmonary thromboembolism is a serious disorder because hypoxemia and pulmonary hypertension progress, finally resulting in respiratory and right-side heart failures. We evaluated the results of surgical treatment in patients in whom circulatory arrest was induced under profound hypothermia. Between 1995 and April 2004, 89 cases were surgically treated. The pathologic condition of these patients was classified as being degree III or greater in the NYHA classification. Following a median sternotomy, profound hypothermia was induced using cardiopulmonary bypass, and pulmonary thromboendarterectomy in the bilateral pulmonary arteries was performed under intermittent circulatory arrest. Of the 89 patients, 4 of 5 who underwent emergent surgery died after postoperatively. Among 84 patients who underwent elective surgery, 7 died of respiratory and cardiac failure. Clinical symptoms were markedly improved by surgery in 73 patients. Because this disease is resistant to medical treatment, pulmonary thromboendarterectomy using intermittent circulatory arrest under profound hypothermia is effective in treating patients with chronic thromboembolic pulmonary hypertension.