Chronic, Massive Thrombotic Obstruction of the Pulmonary Arteries

Four patients with extensive, chronic pulmonary arterial thrombotic obstruction, are presented in whom thromboendarterectomy was attempted. The procedure was successful in two, both of whom are alive and well more than 2 years since surgery; it was unsuccessful in two, both of whom succumbed in the postoperative period. The clinical and laboratory diagnostic approach to such patients is discussed. Criteria for selection of operative candidates are reviewed and certain technical decisions considered. It is concluded that selected patients with chronic massive occlusion can be improved significantly by thromboendarterectomy, but further experience is required to improve criteria for the selection of surgical candidates. The poor experience with two patients in advanced right ventricular failure already has indicated that one essential factor in reducing surgical risk is diagnosis prior to overt cardiac decompensation.