[Results of thrombo-endarterectomy of chronic pulmonary embolism]

Between 1973 and 1987, 33 patients underwent pulmonary thromboendarterectomy for chronic pulmonary embolism. Twenty-six patients were in Class III of the NYHA Classification, 5 in Class IV with overt right ventricular failure and 2 in Class II. The average pO2 was 60 mmHg under basal conditions without oxygen therapy. The amputation of the pulmonary vascular tree was greater than 50 per cent in all patients. The average systolic pulmonary artery pressure was 70 mmHg. Twenty patients were operated by a lateral thoracotomy without CPB and 6 by sternotomy with CPB under normothermia with or without cardiac fibrillation. The later method avoids having to open the pleura and seemed to give better haemodynamic control. Interruption of the inferior vena cava was systematic in all cases. The global operative mortality was 20 per cent but this seemed to be less in the patients operated by sternotomy under normothermic CPB (no deaths in 6 patients). The authors consider that this technique should be studied in a larger series of patients. Eighteen patients are still being followed up; the clinical and scintigraphic and/or angiographic improvement is clearcut in the majority of cases.