Do you also feel short of breath or wheezing when you exert yourself, climb stairs, or do ordinary tasks? Sometimes the cause of this can be an old blood clot that has been in your lungs for a long time. Usually, even if you try to control this condition with medication, if that doesn't work, doctors refer you to a special surgery that can save your life. Today we are talking about that complex, but very important surgery, PTE.
What is this PTE surgery?
Simply put, PTE is an abbreviation for Pulmonary Thromboendarterectomy . This is a surgical procedure that removes old blood clots and scar tissue that have been stuck in the main blood vessels (pulmonary arteries) in your lungs. This is a somewhat complicated procedure that requires specialized knowledge. But it can completely cure some patients.
What conditions are treated with PTE surgery?
This surgery is mainly done to treat a condition called CTEPH (Chronic Thromboembolic Pulmonary Hypertension) . You might think, 'That's a really long name,' right? Let's keep it simple.
Imagine, someone has a blood clot in their lungs. We call it ``Pulmonary Embolism (PE)``. Most of the time, these blood clots dissolve when they are given blood thinners. But very rarely, in some people, these blood clots do not dissolve completely, but stick to the walls of the blood vessels in the lungs, and over time, turn into scar tissue.
When old blood clots and scar tissue block the blood vessels in the lungs, the blood pressure inside those vessels becomes too high. That's what we call CTEPH.
This causes the right side of the heart to have to work harder to pump blood to the lungs. Over time, this can lead to serious conditions such as heart failure and lung damage. The only treatment that can cure CTEPH is PTE surgery.
Who needs this surgery? Can everyone have it?
If you have CTEPH, several factors will determine whether you can have PTE surgery.
| Consideration | Description |
|---|---|
| Severity of symptoms | How severe your symptoms are, such as shortness of breath and wheezing. |
| Location of blood clots | The fact that blood clots and scar tissue are also located in places where they can be safely removed surgically. |
| Your overall health | Your age, heart and lung function, and whether you have other medical conditions are also important. |
Not all CTEPH patients are eligible for this surgery. Approximately 40% of patients are not eligible for this surgery. The reason for this is that it is a very complex surgery.
Why is the surgery so complicated?
Imagine that during surgery, your heart and lungs are put on a cardiopulmonary bypass machine to help with some of the work. Then, to allow the surgeon to see inside your lungs, your body temperature is lowered to 18 degrees Celsius (65°F), and your blood circulation is stopped for a moment. This is called a `deep hypothermic circulatory arrest.` Don't worry, this procedure allows the surgeon to remove blood clots and scar tissue very cleanly while protecting your brain from any damage.
How to prepare for surgery?
Your doctor will give you all the instructions you need before the surgery. They will usually tell you to pay attention to these things:
- Medications: You will be asked to stop taking blood thinners (such as aspirin and warfarin) and some pain relievers (NSAIDs) a few days before surgery, as these can increase the risk of bleeding during surgery.
- Food and Drink: You will be asked to fast (not eat or drink) for several hours before surgery. It is safer to have an empty stomach when the anesthesia is given.
- Smoking and alcohol: If you use both, it is very important to stop completely before surgery, as they delay the healing process and increase the risk of complications.
What happens after the surgery?
After surgery, you will be admitted to the intensive care unit (ICU). You will stay there that night. The next morning, they will check if you can breathe on your own and then remove the ventilator.
You will usually stay in the hospital for 7 to 10 days. During this time, you will gradually begin to walk. You will also have some tests to see if you need oxygen before you go home. This is a similar experience to recovering from open heart surgery.
What are the benefits and risks?
Like any surgery, PTE has both benefits and risks.
| Advantages | Risks |
|---|---|
| The possibility of complete recovery from CTEPH. | The risk of death during surgery (now as low as 1%). |
| Significant improvement in breathing and exercise ability. | Risk of stroke (1%-2%). |
| Recovery of damage to the right side of the heart. | The pulmonary hypertension (PH) remains at a certain level even after surgery. |
| The ability to live a long, healthy life after surgery. | Accumulation of fluid around the heart (pericardial effusion). |
Emergency!
If you experience sudden , severe chest pain, severe shortness of breath, or fainting after surgery, go to the nearest hospital's Emergency Department (ETU) immediately. Also, if you develop symptoms such as swelling, redness, pus, or fever at the surgical site, see your doctor immediately.
How is the recovery time?
It takes about 3 months to fully recover.
- First 6 weeks: No driving, going to work, or lifting more than 4.5 kg (10 lbs).
- Weeks 7 to 12: Can lift up to 11 kg (25 lbs).
- After 12 weeks: There are usually no restrictions.
Your breathing and exercise ability may gradually improve up to 4 years after surgery.
Take-Home Message
- Although PTE is a complex surgery to remove old blood clots in the lungs, it can completely cure the condition called CTEPH.
- This surgery is not for everyone. Your doctor and team of specialists will decide if it is right for you.
- Although the recovery time is a little longer, your quality of life, breathing ability, and mobility will improve significantly after surgery.
- After surgery, you will need to take anticoagulants for the rest of your life to prevent blood clots from forming again.
- It is essential to see your doctor on time and get tested. Don't be afraid to talk to your doctor about any discomfort you may be experiencing.
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