The pulmonary thromboendarterectomy, abbreviated as (PTE) or pulmonary endarterectomy (PEA), is a surgery to extract the chronic blood clot from the arteries in an individual’s lungs. These blockages happen because of (CTEPH) chronic thromboembolic pulmonary hypertension.
CTEPH is a rare complication in individuals with blood clots in their lungs. This surgery is conducted when the medications are not effective anymore. However, in most cases, early diagnosis can effectively cure the condition.
What disorder does (PTE) pulmonary thromboendarterectomy treat?
The PTE is conducted to treat blockages in individuals with CTEPH. However, CTEPH is a rare illness that might arise in individuals with blood clots in their lungs, known as pulmonary embolisms.
The CTEPH can cause blockage in the blood flow; in some cases, these blockages respond to thinning blood medication. However, if the clot does not react to the medicine, it can lead to scar tissue which can further cause breathing difficulty. PTE is the only procedure that can cure CTEPH.
Who might need pulmonary thromboendarterectomy PTE?
Individuals who are diagnosed with CTEPH need pulmonary thromboendarterectomy PTE depending upon the following:
- The extent, location, and degree of the artery blockage.
- The severity of the indications and condition.
- The age, health, and condition of the lungs and heart of an individual.
The healthcare provider might recommend PTE depending on the patient’s health condition. However, four out of ten individuals are not considered suitable for PTE because of the complexity of the surgery.
Patients who are not eligible for PTE are recommended other suitable treatments by their healthcare provider. Treatments like:
- Interventional procedure (BPA or pulmonary balloon angioplasty).
- Oral medication.
The procedure of thromboendarterectomy:
1. PreparationofPTE
- The thromboendarterectomy is performed in a hospital. This surgery is complex; it takes 8 to 10 hours and involves a team of specialized surgeons. Before the process begins, the healthcare advisor will inform the patient whether to fast or stop consuming medicines. The patients are advised to follow their consultant’s guidelines for the following:
2. Food and drink
- The healthcare advisor team will inform the patient whether to fast before the surgery or not, as anesthesia is safer when the patient’s stomach is empty.
3. Medications
- Most patients stop consuming blood thinners that aid in preventing blood clots. Moreover, it is beneficial to inform the consultant about any medicine the patient consumes before the surgery so that the consultant can work accordingly.
4. Alcohol and smoking
- The healthcare advisor will advise the patient to stop drinking alcohol and quit smoking, as both tobacco and alcohol can increase the risks of complications.
What happens during PTE?
The patient is given anesthesia for the PTE procedure, typically beginning early in the morning and at least staying for about 6 hours.
During the thromboendarterectomy process, the healthcare advisor will:
- Inject an (ETT) endotracheal tube through the patient’s nose or mouth to the airways and will join it to an oxygen machine to aid the patient in breathing.
- Make an incision in the patient’s (breastbone) sternum to reach the patient’s lungs and heart.
- Joins the patient to a cardiopulmonary bypass machine, which performs like the individual’s heart and lungs during the PTE process.
- Slowly cools the patient’s anatomy to 65 degrees Fahrenheit (eighteen degrees Celsius).
- The healthcare advisors’ team will utilize particular instruments to extract scar tissues and clots from the patient’s arteries.
- Warm the patient’s anatomy to their usual body temperature, remove the bypass machine and leave the patient connected to the oxygen machine.
- Closes the patient’s chest and leaves the tubes to drain extra fluid from the patient’s anatomy.
What happens after the pulmonary thromboendarterectomy?
- After the PTE procedure is completed, the patient is shifted to the intensive care unit (ICU). The med team will test the patient’s breathing ability and remove the patient from the breathing machine if the patient can breathe without support.
- The patient is put under observation for about seven to ten days.
What is the recovery time for a pulmonary thromboendarterectomy?
- A patient’s recovery period with a thromboendarterectomy depends upon the patient’s health factors. The recovery of PTE is similar to open-heart surgery. The patient might start walking within a few days. However, the patient will not be able to work, drive or lift anything heavier than ten pounds for at least six weeks after the surgery.
- In most cases, patients can follow their routine within three months of surgery.
What is the possible risk factor of thromboendarterectomy?
After the thromboendarterectomy process, the risk of experiencing a stroke is one to two percent, and some people may have some degree of pulmonary hypertension. Furthermore, in some cases, the fluid builds up surrounding the heart, known as pericardial effusion and develops after surgery. After the PTE, the patient can experience the following:
- Fainting.
- Chest pain.
- Difficulty in breathing or shortness of breath.
References
- https://my.clevelandclinic.org/health/treatments/21024-pulmonary-thromboendarterectomy-surgery retrieved on 18 October 22
- https://www.healthgrades.com/right-care/vascular-conditions/thromboendarterectomy retrieved on 18 October 22
- https://www.mayoclinicproceedings.org/article/S0025-6196(11)61732-1/fulltext#:~:text=Pulmonary%20thromboendarterectomy%20is%20indicated%20in,right%20ventricular%20(RV)%20hemodynamics.retrieved on 18 October 22
