An intricate surgical procedure performed by surgeons with Houston Methodist DeBakey Heart & Vascular Center can bring relief to patients suffering from chronic thrombo embolic pulmonary hypertension (CTEPH).


CTEPH is a condition that occurs when blood clots that have migrated to the lung thicken over time and close off the pulmonary vessels, prohibiting the proper amount of blood flow from the right side of the heart, through the lungs, to the left side of the heart. This causes patients to experience shortness of breath, fatigue, etc.


According to Mahesh Ramchandani, M.D., a cardiovascular surgeon with Houston Methodist DeBakey Heart & Vascular Center, the procedure called a pulmonary thromboendarterectomy (PTE) is the only curative option for these patients.


“The surgery involves opening the chest, putting the patient on the heart-lung machine, and opening the pulmonary arteries so that we can access all the branches extending to the periphery of each lung,” Ramchandani said. “Once we locate the clots, we have to precisely remove them from the inside of all these branches. It’s a very delicate procedure that takes a special kind of expertise.”


Some 300,000 people experience a pulmonary embolism every year in the United States and about 5 to 10 percent develop CTEPH. Ramchandani says there are many reasons why a patient might experience shortness of breath and fatigue and for this reason CTEPH is often not diagnosed.


“There is a simple test called a ventilation perfusion scan that can detect airflow and blood flow in the lungs and detect CTEPH in people with symptoms. This can be done by a patient’s primary care physician,” Ramchandani said. “The key is getting patients properly diagnosed in a timely manner.”


Houston Methodist Hospital is the only institution accredited by the Pulmonary Hypertension Association as a Comprehensive Care Center for Pulmonary Hypertension in the Houston area and the CTEPH program is the only one in the state of Texas and surrounding states. Pulmonary hypertension experts work closely with the surgical team to determine if patients can be managed with medications or if a PTE is necessary. Ramchandani says putting together this CTEPH program is a true team effort involving Houston Methodist pulmonologists and cardiologists.


“If patients are diagnosed correctly and quickly, we now have the surgical expertise and the entire team in place at Houston Methodist to help patients with CTEPH better manage their disease and have a better quality of life,” Ramchandani said.


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