Echocardiographic Evaluation of Chronic Thromboembolic Pulmonary Hypertension before and after Pulmonary Artery Endarterectomy: A Case Series

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious and under diagnosed disorder with significant morbidity and mortality. For reasons that are still unclear, the lyses of blood clots does not occur in some survivors with acute pulmonary thromboemboli, which then evolve into the organization of the clot inside the pulmonary artery and CTEPH. Obstruction of the pulmonary artery results in increased vascular resistance and thereafter right heart strain and remodeling. Pulmonary artery endarterectomy is the treatment of choice with good outcome in these patients. Objectives: The aim of the present study was to evaluate right ventricular function and pulmonary artery pressure before and then after pulmonary thrombo-endarterectomy for a preoperative classification system and risk stratification to aid in patient selection. Methods: In this study, all clinical and paraclinical data such as echocardiographic data of patients with CTEPH were obtained before and after pulmonary thrombo-endarterectomy. Results: Pulmonary thrombo-endarterectomy was associated with significant improvement in right ventricular size (p value = 0.024), systolic pulmonary arterial pressure (p value = 0.012), and functional exercise capacity (p value = 0.007), but right ventricular systolic function did not show significant improvement after that. Conclusion: Pulmonary endarterectomy by well-experienced surgical and medical teams is the method of choice for the treatment of CTEPH with good long-term results and acceptable mortality and morbidity.