Case 1-2011: The challenges posed by a complicated pulmonary thromboendarterectomy

HEN DISCUSSING heart failure, the left ventricle normally takes center stage, and the right ventricle (RV) can become an afterthought. However, in patients diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH), the RV takes the lead role. These patients can present with increased right ventricular oxygen consumption with a concomitant decrease in right ventricular oxygen supply, placing them at high risk for right ventricular ischemia and failure. Fortunately, after a pulmonary thromboendarterectomy (PTE), rightheart hemodynamics greatly improve in most CTEPH patients, and right ventricular perfusion is no longer an issue. The authors, however, present a case discussing the management of a patient with severe pulmonary hypertension (PH) undergoing a PTE with residual severe PH even after their PTE.