Chronic Thrombo Embolic Pulmonary Hypertension (CTEPH)

Chronic Thrombo Embolic Pulmonary Hypertension is a relatively rare condition which is a long term complication of Pulmonary Embolism from Deep Vein Thrombosis. This condition results in the Lung circulation getting clogged and blocked with the clots which gets adherent to the blood vessel supplying the lung (Pulmonary Artery)

This leads to the, pressure in the Pulmonary Artery (Pulmonary Arterial Hypertension) to go up. The pressure in the Pulmonary Artery is usually 15-20% of the normal BP.

The pressures in the Pulmonary artery gradually goes up in CTEPH and in extreme conditions reaches the systemic pressure upto 100-120 mm Hg. This leads to deterioration of function of the right side of the heart.

When To approach the Doctor?

Patients who are having combinations of these Signs:

• Chest Pain

• Syncope (Fainting)

• Fatigue

• Breathing difficulty

• In extreme conditions, fluid accumulation in the body with the swelling of the feet

How it is Confirmed:

Doctors diagnose this condition based on

• ECHO

• CT Scan of Pulmonary arteries

• Ventilation Perfusion scans (VQ scans).

What Can Be Done?

With medical treatment this condition can be partially reversed and treated. But the prognosis of this condition is quite poor and the median survival of these patients who develop significant Pulmonary Hypertension is less than 3 years.

These patients are started on life long blood thinning tablets like Acitrom or Warfarin. They are also given medicines to reduce the pressure in the Pulmonary artery. Medical Treatment does help in the initial stages. 

Surgical Therapy with Pulmonary Thrombo-Endarterectomy (PTE) of these layered clots is the definitive treatment.

Surgery:

Pulmonary Thrombo Endarterectomy is a major surgery done only in a handful of centers across the country.

PTE involves connecting the patient to the heart lung machine, cooling the patient to 18 degree Celsius and stopping the circulation completely ( Deep Hypothermic Circulatory Arrest) The surgical team opens the Pulmonary Artery and creates a plane to remove these layered clots.

Pulmonary Thrombo Endarterectomy is a technically challenging surgical procedure which needs an excellent Anaesthesia and Intensive care back-up.

With a successful surgery, the patients recover well with the pulmonary arterial pressure returning to near normal levels. They get back to normal activities within  a few weeks.

It is done Here?

Though this is a high risk surgery the results of this procedure is very rewarding. These patients need to be on life long medications with blood thinners. The quality of life regained is excellent.

The team led by Dr Anbarasu Mohanraj takes special interest in this complex  surgical procedure and he has also taken special training to perform this procedure from University of California - San Diego which is a center of excellence in this complex surgery.