Surgery is a potential option for some patients with chronic thromboembolic pulmonary hypertension (CTEPH; Group 4 PH). For some with CTEPH, a surgery called pulmonary endarterectomy (PEA) may be appropriate, in which residual clot and scar material are cleared from the pulmonary vessels. Decisions regarding this procedure are made on a case-by-case basis and depends on characteristics of the residual clot, as well as your personal preferences. As this surgery requires special expertise in a specialised centre, patients in Ireland who require this procedure are referred to the Royal Papworth Hospital in the UK. The provision of financial support has to be obtained from the relevant health authority before travel can take place.
Papworth Hospital provide an excellent overview of the procedure on their website.
Image of scar tissue and clot removed following pulmonary endarterectomy surgery for CTEPH
If PEA is not considered feasible or you decide against it, there are additional interventional options for the management of CTEPH, including a procedure called balloon pulmonary angioplasty (BPA). This employs a small balloon to stretch open the scarred pulmonary vessels to improve blood flow and often requires several procedures in order to improve blood flow. This is also performed in Papworth in the UK.
The Mater hospital is also the site of the National heart and lung transplant unit. People with pulmonary hypertension (without congenital heart disease) may be referred for assessment regarding suitability for double lung transplantation if they have progressive debilitating pulmonary hypertension, despite maximum medical therapy. Further information regarding the Mater Hospital transplant team and the associated assessment process can be found in the Mater Hospital Lung Transplant Patient Information Booklet.