After an acute pulmonary embolism (PE), nearly half of patients are still symptomatic. In the most serious sequela of PE, the blood clots solidify or scar the vessels, resulting in chronic thromboembolic pulmonary hypertension (CTEPH). Unlike most forms of pulmonary hypertension (PH), CTEPH is curable. If not treated, however, patients have an average life expectancy of three years.

“If a patient is still short of breath and has imaging concerning for PE three months after the initial treatment, they should be referred to a center that specializes in CTEPH treatment,” says Sudarshan Rajagopal, MD, PhD, co-director of the Duke Pulmonary Vascular Disease Center. “There are only a few places in the country that do it well, and we’ve performed more than 600 CTEPH procedures. We’ve been treating CTEPH for over a decade with an institutional experience unparalleled in the Southeast.”

“Few physicians understand how effective treatments are for CTEPH,” says Jacob N. Schroder, MD, Duke’s surgical director for advanced heart failure. “The likelihood of returning to a normal quality of life is excellent. The effects are immediate.”

Duke Health is one of the few centers in the country that treats CTEPH. Treatments include:

• Pulmonary endarterectomy (PEA), an open surgery that clears obstructions from the pulmonary arteries
• Balloon pulmonary angioplasty (BPA), a minimally invasive vascular procedure to open the pulmonary arteries

PEA is considered the most effective treatment for CTEPH and requires intensive training to perform. “It’s a very specialized operation, unlike anything else we do in cardiac surgery,” Schroder says. “For optimal outcomes, you have to clear out not only the arteries but also the segmental and subsegmental branches. Referring patients to an experienced surgeon gives them the most efficient, safest, and most effective result.”

PEA requires sternotomy. For patients who are not surgical candidates, BPA and medical management offer effective alternatives.

Early referral is key for positive patient outcomes. “CTEPH is a progressive condition,” says Rajagopal. “The longer you wait, the worse the outcomes will be. Waiting puts the patient at a much higher risk of worsening right heart failure and death.”

“We always advise treating sooner,” Schroder agrees. “The sooner you take care of the problem, the sooner the patient’s quality of life returns to normal. You also have fewer systemic effects of CTEPH, such as kidney and liver dysfunction.”

Duke Heart is a comprehensive PH center. “We provide every aspect of care across the spectrum of PH,” says Rajagopal. “We’re here to comanage these conditions along with local providers.”