Pulmonary Thromboendarterectomy

(Also called: PTE)

Purpose

The purpose of a pulmonary thromboendarterectomy is to remove blood clots that are blocking the pulmonary arteries in order to allow the right side of the heart to work properly. Also, with the clots out of the way, blood can get to all parts of the lungs, and oxygen delivery is improved.

Blood clots can form in the body’s veins, usually in the veins of the legs. If they break loose, they are called emboli. The emboli are swept by the blood through the veins to the right side of the heart. The right side of the heart pumps blood to the lungs where the emboli become lodged in the branches of the pulmonary (lung) arteries.

Emboli in the pulmonary arteries can cause several problems. If enough of these arteries are blocked, the amount of oxygen delivered to the blood is decreased. These blockages in the arteries in the lungs also make it harder for the right side of the heart to pump properly. The pressure in the blood vessels in the lungs increases, resulting in pulmonary hypertension.

The right ventricle of the heart also must work harder to pump blood through the partly blocked pulmonary arteries. The right ventricle gets bigger and thicker trying to do the extra work. If it is stressed too much, heart failure can occur.

Description

1. A number of tests are done in the hospital before the procedure. These include CT scan, echocardiogram, angiogram, blood tests, chest X-ray, and MRI.
2. The patient and family members are thoroughly educated about the procedure.
3. A nurse or doctor asks the patient to provide informed consent. This consent is required before the procedure is performed.
4. The patient is taken to the Cardiac Operating Room.
5. The patient is placed under general anesthesia and remains unconscious for the entire operation.
6. Incisions (cuts) are made through the patient’s chest and breastbone to allow the surgeons access to the heart.
7. The heart’s blood vessels are connected to a heart-lung machine (also called a heart-lung bypass machine), which pumps the patients’ blood through the body during the surgery.
8. Once the heart-lung machine is pumping blood, the patient’s body is cooled to a temperature far below normal. This makes it possible to temporarily stop the circulation of blood without damaging cells in the body.
9. When the heart-lung machine is stopped, blood will stop flowing through the blood vessels. The surgeon then opens and removes the clots and any built-up plaque from the pulmonary arteries. Depending on how many clots need to be removed, the heart-lung machine may need to be started and stopped several times.
10. The heart-lung machine is restarted, and the patient’s body is warmed back up to a normal temperature.
11. After the patient’s body is a normal temperature, the heart-lung machine is removed and the heart may need to be started with a small electrical shock.
12. The patient stays in the Cardiac Surgery Intensive Care Unit (CSICU) for three to 10 days. The patient may be kept unconscious for several days to allow the lungs to begin to heal.
13. A breathing tube is kept in place for two to seven days, or possibly longer.
14. The patient is moved from CSICU to a regular hospital room. The average hospital stay after a pulmonary thromboendarterectomy is two weeks or more.

Patient Instructions

Extensive instructions for patients, including how to prepare for and what to expect after surgery, are available in the Pulmonary Thromboendarterectomy Patient Guide.