Pulmonary Embolism/ Thromboendarterectomy

Keith Wille, MD
The UAB/HSF Pulmonary Thromboendarterectomy Clinic has the following objectives:

  1. To provide comprehensive, state of the art clinical and surgical care to patients with pulmonary vascular disease due to chronic thromboembolic pulmonary hypertension (CTEPH)
  2. To serve as a regional educational resource for physicians and sub-specialty trainees in pulmonary, cardiology, radiology, pathology, anesthesia and cardiothoracic surgery and
  3. To acquire new knowledge through maintenance of a database, clinical trials, and refinement of surgical technique, and to disseminate that knowledge by way of publication and other educational activities.

What is CTEPH?
Chronic thromboembolic pulmonary hypertension (CTEPH) is an unusual and progressive disease that causes pulmonary arterial occlusion, gas exchange impairment, right heart failure and eventually death in 3-5 years if left untreated. Although the exact figures are not available, the incidence of pulmonary hypertension in patients surviving an acute pulmonary embolus (600,000/year in the U.S.) is about 0.1%. The disease is sufficiently uncommon and presenting symptoms non-specific that most individual practitioners do not have sufficient patients to develop expertise in its management.

How is CTEPH treated?
The management of CTEPH has evolved over the past decade from a strategy that emphasized anticoagulation (blood thinners) and lung transplant to one that focuses primarily now on surgical resection, namely pulmonary thromboendarterectomy, as well as novel vasodilator agents where feasible.

What will the evaluation consist of?
All patients complete an information form and provide available records and x-rays to be reviewed before an evaluation in Birmingham is scheduled. Patients referred to the clinic undergo a protocol evaluation using an established clinical pathway to determine the actual diagnosis, obtain baseline data required for monitoring and assess the likelihood for successful surgical resection. Initial evaluation includes pulmonary function tests, echocardiogram (ultrasound study of the heart), CT angiogram, an assay to evaluate the presence of a hypercoagulable state and pulmonary arteriogram. Drs Wille and McGiffin complete a comprehensive clinical evaluation of all patients and a multidisciplinary team assists with the final decision to proceed with the surgery. Follow up after the operation includes monitoring of hemodynamic recovery and return of exercise capacity. Patients who are not surgical candidates are referred to the Pulmonary Hypertension and Lung Transplant Clinics at UAB to discuss alternative treatment strategies.

Appointments/Contact information:
Phone: (205) 934 7941
Fax: (205) 934 1721

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