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Seminars in Cardiothoracic and Vascular Anesthesia
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*Pulmonary Embolism
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Chronic Thromboembolic Pulmonary Hypertension and Pulmonary Thromboendarterectomy

Gerard R. Manecke, Jr, MD

Department of Anesthesiology, Thornton Hospital, UCSD Medical Center, 9300 Campus Point Drive, La Jolla, CA 92037 gmanecke{at}UCSD.edu

William C. Wilson, MD

Departments of Anesthesiology, University of California San Diego, San Diego, CA

William R. Auger, MD

Departments of Surgery, University of California San Diego, San Diego, CA

Stuart W. Jamieson, MD

Departments of Medicine, University of California San Diego, San Diego, CA

Chronic thromboembolic pulmonary hypertension results from incomplete resolution of a pulmonary embolus or from recurrent pulmonary emboli. Its incidence is underappreciated, and it is currently an undertreated phenomenon. Pulmonary thromboendarterectomy is currently the safest and most effective treatment for this condition. The surgery involves midline sternotomy, profound hypothermic circulatory arrest, and complete endarterectomy of the pulmonary vascular tree. Success depends on effective coordination of multiple medical teams, including pulmonary medicine, anesthesiology, and surgery. This review, based on the past 30 years of experience at University of California San Diego Medical Center, includes information about the clinical history, diagnostic workup, anesthesia, surgical approach, and postoperative care. Outcome data are discussed, as are avenues for future research.

Seminars in Cardiothoracic and Vascular Anesthesia, Vol. 9, No. 3, 189-204 (2005)
DOI: 10.1177/108925320500900302
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