In Prague, they performed the 500th operation of a patient with chronic thromboembolic pulmonary hypertension

In order to remove blood clots from the pulmonary vessels and make them passable, cardiac surgeons had to connect the woman to extracorporeal circulation, cool her to a body temperature of 17 to 20 degrees Celsius, and for the most important part of the operation, they had to stop her extracorporeal circulation as well.

Only in this way is it possible to safely remove all obstructions from the pulmonary arteries and at the same time protect the brain from damage. The demanding operation took place on II. Surgical Clinic of Cardiovascular Surgery of the 1st Faculty of Medicine of the UK and VFN in Prague in the Pulmonary Hypertension Center of the VFN – at the largest workplace for the diagnosis and treatment of pulmonary hypertension in the Czech Republic.

Surgery for chronic pulmonary thromboembolic hypertension takes place under general anesthesia with the use of extracorporeal circulation and cooling the patient to 17 to 20 degrees Celsius.

“Thanks to the cooling, we can stop the blood circulation and safely open the pulmonary arteries. If we did not completely stop circulation, including extracorporeal circulation, the operative field would be constantly filled with blood. The lungs also have collateral circulation, which constantly brings blood to the lungs even when the heart is stopped. In addition, the low temperature protects the brain, which at normal temperature is damaged after four minutes without oxygen,” explained the procedure of the unique procedure, professor Jaroslav Lindner, deputy head II. Surgical clinics of cardiovascular surgery of the 1st Faculty of Medicine of the UK and VFN and a top surgeon who introduced this procedure in the Czech Republic in 2004.

“When the patient is hypothermic, the safe arrest time at 20 degrees is roughly twenty minutes. During that time we have to clear the artery. With cooling and heating of the patient, the operation takes a total of six to seven hours,” he continued.

In the past twenty years, he has personally performed most of the 500 operations for chronic thromboembolic pulmonary hypertension in the Czech Republic, and together with his student Tomáš Prskavec, they are the only ones who perform these unique surgical operations in the Czech Republic. They operate not only on patients from the Czech Republic, but also from Slovakia or Romania and also from Ukraine.

Thromboembolic pulmonary hypertension is a relatively rare disease that arises as a chronic consequence of repeated pulmonary emboli. These are caused by blood clots released from the lower limbs or pelvis into the pulmonary arteries.

“In patients, there is insufficient dissolution of blood clots, which causes an obstacle to blood flow. The result is high pressure in the pulmonary arteries and gradual exhaustion of the right heart ventricle. Thanks to the operation, the pressure will be reduced and the flow of the lung areas and the normal function of the heart will be restored,” explained Lindner about the course of the disease.

The 500th patient, who underwent surgery at VFN on April 25, also had a similar course of the disease. Thanks to the operation, the doctors significantly and long-term improved the patient’s prognosis, removed the symptoms of the disease and signs of heart failure. Without the intervention of doctors and treatment, she could otherwise die.

“Before, we only diluted the patients’ blood. Then we introduced this unique operational performance. Medicines can also slow down and improve the disease. And for patients who are not suitable for surgery, are seriously ill or have peripheral disabilities, we use the catheterization method. The advantage of our complex center is that we can treat almost all patients who want to be treated and offer them all types of treatment,” said Pavel Jansa, head physician of the VFN Center for Pulmonary Hypertension, adding that chronic thromboembolic pulmonary hypertension develops into two years in roughly four percent of patients who survived acute pulmonary embolism. At the VFN, they diagnose about fifty patients a year, of which roughly thirty undergo surgery.

According to Heřmánková, only a few workplaces in Europe perform unique operations for thromboembolic pulmonary hypertension, which require interdisciplinary team cooperation. Among the largest are centers in Paris, Vienna, Bad Neuheim in Germany or Cambridge.