After visiting the emergency room with fainting spells and shortness of breath, a 17-year-old Morningside Heights boy was diagnosed with rare, life-threatening blood clots blocking his pulmonary arteries. To address the problem, surgeons at NewYork-Presbyterian Hospital Morgan Stanley Children's Hospital successfully performed a pulmonary thromboendartectomy (PTE) surgery -- reportedly, the first time it has been performed on a child in the New York City area.
In the complex, eight-hour open procedure, surgeons stopped the patient's heart, hooked him up to a heart-lung bypass pump, and cooled him to 18 degrees Celsius, or 64 degrees Fahrenheit, in order to reduce his body's need for oxygen. They then opened his pulmonary artery, shut off the bypass pump in order to eliminate blood flow, and removed several large branching clots. The process was repeated for each artery.
Leading the surgery was Dr. Matthew Bacchetta, a thoracic surgeon at NewYork-Presbyterian Morgan Stanley Children's Hospital and NewYork-Presbyterian Hospital/Columbia University Medical Center; and assistant professor of surgery at Columbia University College of Physicians and Surgeons. Dr. Bacchetta learned the technique of PTE surgery at the University of California at San Diego (UCSD), where it was developed.
"Before the surgery, this patient could barely walk across the room, and because he couldn't effectively oxygenate his blood, he was at risk of heart failure. Today he is walking around without oxygen, and his long-term prospects are excellent," says Dr. Bacchetta. "Because he may be at risk for other blood clotting, he is taking blood thinners and will be closely monitored."
PTE is an attractive alternative to lung transplantation, notes Dr. Bacchetta, who also performs lung transplants. "With transplantation, patients must wait for an organ, and then once the transplant occurs, they require lifelong treatment with immunosuppressant drugs. Also, PTE is associated with better long-term survival."
Pulmonary Embolism and Chronic Thromboembolic Pulmonary Hypertension
Pulmonary embolism (PE) is a blockage of the pulmonary artery or one of its branches, usually occurring when a deep vein thrombus (blood clot from a vein) becomes dislodged from its site of formation and travels, or embolizes, to the arterial blood supply of one of the lungs. Acute PE is the third most common cause of death (after heart disease and cancer). More than half a million Americans are afflicted annually, although the condition is greatly underdiagnosed. The causes of pulmonary embolism may include genetic factors, acute injuries such as broken bones, cancer, or a sedentary lifestyle. In chronic thromboembolic pulmonary hypertension (CTEPH), the blockage affects the ability of the heart to oxygenate blood, putting the patient at risk for heart failure. Although the true incidence of new cases of CTEPH is not known, recent studies suggest that it is probably greater than 2,500 new cases every year. It rarely occurs in children. The cause may be a genetic disorder that leads to hypercoagulation that predisposes the patient's blood to clot more easily.
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