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Eur J Cardiothorac Surg 2006;30:241-243
© 2006 Elsevier Science NL

Editorial comment

Department of Cardiothoracic Surgery, University of California San Diego Medical Center, 200 West Arbor Drive, Mail Code 8892, San Diego, CA, USA

^_* Corresponding author. Tel.: +1 619 543 7777; fax: +1 619 543 2652. (Email: sjamieson@ucsd.edu).

The first 300 words of the full text of this article appear below.

Pulmonary endarterectomy is now an established therapy for the pulmonary hypertension caused by thromboembolic disease. It has had a painful acceptance, both in terms of clinical recognition and in the appreciation that this is a curable condition with surgery.

Means and Mallory [1] reviewed the entity of chronic thrombosis of the pulmonary arteries in 1931 and could find only six cases. Hollister and Cull [2] in 1956 stated, ‘it is probable that no more than 200 cases of the syndrome have been reported in the medical literature to date’. Much has changed. However, although chronic thromboembolic disease as a cause for pulmonary hypertension is now well recognized, many patients remain undiagnosed.

With regard to surgical treatment, there has also been increasing acceptance of the fact that thromboendarterectomy can cure this crippling and deadly condition. In 1984, Chitwood et al. [3] reviewed the world's literature to date and found a total of 85 cases managed surgically, with a mortality of 22%.

In 2006, perhaps less than 3000 of these operations have now been carried out worldwide, but it is gratifying that many centers are now starting to do this procedure. By far, the majority of operations (more than 2000) have been done at the University of California, San Diego, which has been promoting the operation for 35 years. The major experience at UCSD (1800 operations) has been gained over the last 15 years. During this time, the operation has been refined, and the last surgical report [4], analyzing in detail a cohort of 500 patients, demonstrated a mortality of 4.4%, with no cerebral complications.

There are, of course, many ways to perform any procedure, and there is no doubt that further modifications will result in better techniques and improved results. However, as it presently stands, results of new techniques have . . . [Full Text of this Article]

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