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Thromboendarterectomy for Chronic, Major-Vessel Thromboembolic Pulmonary Hypertension: Immediate and Long-Term Results in 42 Patients

KENNETH M. MOSER, M.D.; PAT O. DAILY, M.D.; KIRK PETERSON, M.D.; WALTER DEMBITSKY, M.D.; JONATHAN M. VAPNEK, M.D.; DEBORAH SHURE, M.D.; JOE UTLEY, M.D.; and CAROL ARCHIBALD, B.S.N., M.P.H.
[+] Article and Author Information

▸Requests for reprints should be addressed to Kenneth M. Moser, M.D.; University of California, San Diego, Medical Center, Pulmonary and Critical Care Division, 225 Dickinson Street; San Diego, CA 92103-1990.


San Diego, California


©1987 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1987;107(4):560-564. doi:10.7326/0003-4819-107-4-560
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Since 1970, forty-two patients with pulmonary hypertension due to chronic, thromboembolic obstruction of the major pulmonary arteries have had pulmonary thromboendarterectomy at the University of California, San Diego, and the San Diego Veterans Medical Centers. Duration of symptoms before admission averaged 4.4 years, with many alternative diagnoses having been made. At admission, 29 patients had class IV disease by New York Heart Association criteria, and 12, class III. Immediately after surgery, pulmonary vascular resistance declined significantly (p < 0.001) from 897 ± 352 dynes/s · cm-5 to 278 ± 135 dynes/s · cm-5. Seven patients with class IV disease died in the postoperative period. Of the 35 survivors (mean follow-up, 28 months), 16 had class I disease; 18, class II; and 1, class III. Of the 17 patients who have returned for cardiac catheterization at 4 to 12 months after surgery, a further decline (p < 0.05) in pulmonary vascular resistance has occurred. This experience indicates that the disorder is commoner than we previously suspected and that thromboendarterectomy is feasible, even in patients with severe and protracted hemodynamic compromise.

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