Chronic Thromboembolic Disease

Author: Kathleen Berfield, MD; Michael Mulligan, MD
Institution: University of Washington
Date Reviewed: March 2014
Learning Domain: Adult Cardiac Surgery
Learning Objective: Thromboembolic Disease
PowerPoint File: Chronic Thromboembolic Disease

 

Discussion Points for Conference

  • Work up of Chronic Thromboembolic Disease
  • Work up / Classification of Chronic Pulmonary Hypertension
  • Timing of Surgical Intervention for CTE
  • Surgical Approach(es)
    • Use of CPB / DHCA
    • Thromboembolectomy
  • Expected Outcomes
    • Jamison classification
  • Expected outcomes
  • Perioperative management

 

Indications for Surgery 

  • Significant cardiopulmonary impairment
  • PVR >300 
  • Surgically accessible disease 
  • Limited comorbidities
    • Age <80, parenchymal lung disease, CKD, PVD etc)

 

Learning Points

  • The incidence of chronic thromboembolic pulmonary hypertension is underestimated
  • The etiology of pulmonary hypertension is key
  • The proximal extent of disease determines accessibility
  • Timing of surgery is best delayed to allow time for organization of the thrombus
  • IVC filter placement is a must
  • Judicious use of fluids