Yeditepe University Hospital

Koşuyolu Street No:168, 34718 Kadıköy, Istanbul

Contact

4447000

Mon - Fri: 9:00 - 17:30

CTEPH and Pulmonary Endarterectomy: A Patient Guide

CTEPH (chronic thromboembolic pulmonary hypertension)is a serious condition in which organised blood clots persist in the pulmonary arteries, obstruct blood flow, raise pressure in the lung circulation and put strain on the right side of the heart. Prof. Dr. Selim İsbir explains the causes, symptoms, diagnostic tests and treatment options, including pulmonary endarterectomy, in this patient guide.

What Is CTEPH?

Chronic thromboembolic pulmonary hypertension develops when blood clots in the lung arteries do not resolve completely and become organised scar-like material. Persistent obstruction and changes in the pulmonary vessels raise pressure in the lung circulation and increase the workload of the right side of the heart.

Why Does It Develop?

After a pulmonary embolism, some blood clots may fail to resolve and become organised material that narrows or blocks the pulmonary arteries. A previous pulmonary embolism and some clotting disorders are relevant to CTEPH. Other factors below, such as immobility and major surgery, mainly increase the risk of venous clots and pulmonary embolism:

  • Previous pulmonary embolism
  • Certain clotting disorders
  • Prolonged immobility, a risk factor for venous clots
  • Major surgery, a risk factor for venous clots
Illustration of chronic thromboembolic pulmonary hypertension
CTEPH: persistent pulmonary artery obstruction and its effects on the right heart

What Are the Symptoms?

  • Shortness of breath, especially during activity
  • Becoming tired easily
  • Palpitations
  • Chest pain
  • Fainting, particularly in advanced disease
Please Note Symptoms may develop gradually and be recognised late. Increasing breathlessness needs medical assessment. Sudden severe breathlessness, chest pain or fainting warrants emergency assessment.

How Is It Diagnosed?

Assessment by a specialist team may include:

  • Lung ventilation–perfusion scanning
  • Computed tomography (CT)
  • Echocardiography
  • Pulmonary angiography and other specialist tests when indicated

These tests help assess obstruction in the pulmonary arteries and its effects on the heart. A specialist team determines the full diagnostic work-up.

Treatment Options

CTEPH is treatable. A specialist multidisciplinary team considers the following options:

  • Anticoagulant medicines, usually continued lifelong unless a medical reason prevents their use
  • Surgery: pulmonary endarterectomy (PEA)
  • Balloon pulmonary angioplasty (BPA)
  • Medicines that target pulmonary hypertension when indicated
Pulmonary endarterectomy and removal of organised clot material
Pulmonary endarterectomy: surgical removal of chronic obstructive material from the pulmonary arteries

Pulmonary endarterectomy is the preferred treatment for suitable operable disease. Suitability depends on the location of the obstruction, associated small-vessel disease and the patient's overall condition.

Daily Life and Follow-Up

  • Attend regular medical reviews
  • Take prescribed medicines consistently
  • Follow an exercise plan agreed with your medical team
  • Avoid prolonged immobility where possible
Why Early Diagnosis Matters Timely diagnosis and appropriate treatment can improve symptoms and quality of life. Ongoing follow-up remains necessary.

When Should You Seek Medical Help?

  • Breathlessness is getting worse
  • Daily activities are becoming difficult
  • Fainting or chest pain occurs

Arrange prompt medical assessment. For sudden severe breathlessness, chest pain or fainting, seek emergency care.

Frequently Asked Questions

What is CTEPH?
CTEPH is a form of pulmonary hypertension associated with persistent organised clots and obstruction in the pulmonary arteries. It raises pressure in the lung circulation and strains the right side of the heart.
What symptoms can CTEPH cause?
Symptoms include breathlessness, especially on exertion, fatigue, palpitations, chest pain and sometimes fainting. They may develop gradually, which can delay diagnosis.
What is pulmonary endarterectomy?
Pulmonary endarterectomy is surgery to remove organised obstructive material from the pulmonary arteries. It is the preferred treatment for operable CTEPH in appropriately selected patients and can substantially improve symptoms. Assessment and surgery require an experienced specialist centre.
When should someone with suspected CTEPH see a doctor?
Increasing breathlessness or difficulty with everyday activities needs prompt medical review. Sudden severe breathlessness, chest pain or fainting requires emergency assessment.

Book an Appointment

Prof. Dr. Selim İsbir — Yeditepe University Koşuyolu Hospital

Book an Appointment →