Thrombendarterectomy in chronic pulmonary embolism

Thrombendarterectomy of the pulmonary artery was performed in three cases of chronic pulmonary embolism with pulmonary hypertension and right heart failure. The indications for such tissue-preserving surgery are discussed against the background of the presented cases and of the literature. These indications are unilateral vascular obstruction with good run-off in combination with "moderate" pulmonary hypertension. Patients with peripheral vascular changes in both lungs and equilibrated pressures respond poorly to thrombendarterectomy and present high surgical risk. For such patients hope lies in future resources for combined heart-lung transplantation.