What is PTE

Pulmonary Thromboendarterectomy (PTE)

What is PTE?

Pulmonary thromboendarterectomy (PTE) is a delicate surgical procedure used to remove blood clots and restore blood flow to the lungs. Although many people have blood clots in their lungs,there are a small number of cases in which the clots do not dissolve on their own but instead stick to the vessel wall and obstruct the individual's blood flow. The result of this obstruction is chronic thromboemobolic disease, which causes a type of pulmonary hypertension known as secondary, or chronic, pulmonary hypertension.

People with secondary pulmonary hypertension caused by these blood clots often develop heart failure. PTE can can cure this type of pulmonary hypertension by restoring normal blood pressure in the pulmonary artery and reversing right-side heart failure.

What is pulmonary hypertension?

Pulmonary hypertension (PH) is a lung disorder in which the blood pressure in the pulmonary artery rises far above normal levels. The small arteries of the lung narrow throughout the lungs. Pulmonary hypertension is the result of greater resistance to blood flow. As a result of the increased workload caused by this resistance, the right side of the heart becomes enlarged. Eventually, progressive right heart failure may develop.

When pulmonary hypertension occurs without a known cause, it is know as Idiopathic Pulmonary Arterial Hypertension (IPAH)---meaning that there are no other diseases of the heart or lungs causing the high blood pressure.

The cause of IPAH is unknown. Some cases are inherited and that is known as familial PAH.

This disease is rare, but affects people of all ages and ethnic backgrounds. It affects more women than men.

There are other forms of PAH where the cause is known. A common cause is collagen vascular diseseas such as scleroderma, lupus or Crest Syndrome. Congenital heart diseases such as ventricular and atrial septal defects, HIV infection, and liver disease are also possible causes of pulmonary hypertension.

What causes lung embolisms and what happens as a result?

Lung embolisms form from blood clots originating in the legs and pelvis. These blood clots can dislodge from the vein in the legs and pelvis and travel into the lungs, thus causing a pulmonary embolism.

If the clot is large enough, it can obstruct the blood flow to the arteries, or it can have a slightly more modest effect, where the person finds himself with a little shortness of breath and mild pain. However, there may also be no side effects at all.

If the individual has a few large clots, however, these clots break off and move to the lungs. A person can survive a fair amount of these clots, but ultimately, the body tries to digest them and in the process, it will cause scarring of the lung's arteries. This scarring results in the disappearance of the branches of the lung's arteries, which causes patients to progressively lose the ability to pump blood through their lungs. The PTE operation is designed to cure this.

Who is a candidate for PTE?

The best candidates for PTE are patients with chronic pulmonary hypertension (also known as pulmonary thromboembolic disease), including those with heart failure who are able to move around independently.

Even though pulmonary embolism is one of the more common cardiovascular diseases, PTE remains an uncommon procedure. This is due, in part, to the fact that this form of chronic pulmonary hypertension is still largely an underdiagnosed or improperly diagnosed condition. 

“Usually patients exhibit heart failure, shortness of breath or come in for heart failure," says Dr. Bartley Griffith, UMMC cardiac surgeon. "Pulmonary embolisms are very frequently misdiagnosed. It usually isn't until the person is referred for pulmonary hypertension or lung transplant that this is figured out."

This page was last updated: March 11, 2013

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