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Pulmonary Medicine

UCLA among few to offer specialized PTE surgery for obstructive cardiopulmonary condition

10/01/2009

PTE Surgery Pulmonary arterial hypertension (PAH) includes a spectrum of diseases that develop when pulmonary vessels become narrowed or obstructed. PAH is triggered in some patients when blood clots become lodged in the pulmonary arteries (chronic pulmonary emboli), obstructing blood flow to the lungs and placing a strain on the right side of the heart, known as chronic thromboembolic pulmonary hypertension (CTEPH). If the blockages can be removed, PAH may be dramatically reduced or cured. UCLA is one of only two centers on the West Coast and one of only a handful in the U.S. to offer pulmonary thromboendarterectomy (PTE) as a means to surgically remove chronic pulmonary emboli. For patients with severe, life-threatening CTEPH, PTE may be an alternative to lung transplantation or extensive, long-term medication regimens.

CTEPH is often missed or misdiagnosed

Many types of PAH exist with different causes but similar symptoms, including chronic fatigue, shortness of breath, chest pain, heart palpitations, dizziness, fainting, decreased exercise tolerance and swollen ankles/legs. PAH symptoms often mimic those of other diseases, such as emphysema and congestive heart failure.

Consequently, PAH may be difficult to accurately identify, particularly among patients with CTEPH, who often have no previous history of pulmonary emboli. Tests to diagnose CTEPH may include echocardiogram, ventilation/perfusion nuclear lung scan, chest CT angiogram, cardiac-gated MRI and pulmonary angiogram. Evaluation of CTEPH also includes determining the underlying cause of recurrent blood clots.

Pulmonary thromboendarterectomy (PTE) may cure CTEPH

Patients with CTEPH experience recurrent blood clots that have embolized to the lungs – usually from the deep veins of the legs (deep vein thrombosis) – failed to dissolve naturally or respond to anticoagulant therapies. The clots can organize into fibrous tissue and become embedded in the walls of the major pulmonary arteries. Once this process has occurred, the fibrous tissue can only be removed surgically.

PTE is a highly specialized procedure in which cardiac surgeons, using the heart-lung machine (cardiopulmonary bypass) to supply blood and oxygen to vital organs while the heart is stopped, view and dissect the vessels through an open chest incision and remove organized clots in the lining of the pulmonary arteries. Surgeons place a filter in the main vein leading from the legs to the heart to catch future clots traveling to the lungs. Most patients will receive long-term anticoagulant therapy.

In appropriate patients, PTE can immediately reduce or cure CTEPH by restoring normal circulation in pulmonary vessels and reversing right heart failure. These benefits appear to persist over time. Identifying patients who have the right anatomy is critical to success. Patients with certain types of blockages may not be good candidates for PTE. The pre-operative evaluation is done by a specialized medical and surgical team at UCLA.

Operative mortality is low for this life-saving and dramatically successful surgery. Five-year survival is approximately 75 percent in patients whose life expectancy without surgery is often only a few years.

UCLA offers full continuum of care for some patients with PAH

Some patients with PAH may need long-term medication therapy, surgical treatment or transplantation to manage symptoms and prolong life. At UCLA, patients benefit from access to a comprehensive continuum of care. UCLA has one of the largest PAH programs in the nation as well as heart, lung and heart-lung transplantation programs that rank among the national leaders in volume and outcomes. UCLA offers its patients the convenience of the full range of evaluation and treatment services provided at one center.

Many patients don’t receive appropriate treatment

“Many patients with chronic thromboembolic pulmonary hypertension suffer unnecessarily because they’re misdiagnosed and do not receive appropriate treatment,” explains David Ross, M.D., director of the UCLA Pulmonary Arterial Hypertension & Thromboendarterectomy Program. “Based on their symptoms, patients are often told they’re out of shape or have another condition, such as emphysema or congestive heart failure.”

CTEPH is induced by recurrent blood clots that become lodged in the pulmonary arteries. In appropriate patients, CTEPH can be treated surgically and potentially cured with pulmonary thromboendarterectomy, a highly specialized procedure offered at UCLA and only one other institution on the West Coast. In severe cases, PTE may offer an alternative to lung transplantation or extensive, long-term medication regimens.

UCLA has one of the most active multidisciplinary PAH programs in the nation, according to Dr. Ross. The continuum of care ranges from evaluation and medical management to surgery and lung or heart-lung transplantation.

Participating Physicians

Jamil Aboulhosn, M.D.
Assistant Clinical Professor
Division of Cardiology
Adult Congenital Heart Disease Program
David Geffen School of Medicine at UCLA

David Ross, M.D.
Director, UCLA Pulmonary Hypertension
& Thromboendarterectomy Program
Medical Director, UCLA Lung and
Heart-Lung Transplant Program
Clinical Professor, Division of Pulmonary
and Critical Care Medicine
David Geffen School of Medicine at UCLA

Richard J. Shemin, M.D.
Surgical Director, UCLA Pulmonary
Thromboendarterectomy Program
Professor and Executive Vice-chairman,
Department of Surgery
Chief of Cardiothoracic Surgery
David Geffen School of Medicine at UCLA

Robert Suh, M.D.
Associate Clinical Professor,
Thoracic Imaging, Department of Radiology
David Geffen School of Medicine at UCLA

Contact Information
UCLA Pulmonary
Thromboendarterectomy (PTE) Program
200 UCLA Medical Plaza
3rd floor, Suite B

(310) 825-8061 Appointment
(310) 794-6553 Fax





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