Blockages of the Pulmonary Arteries
Columbia offers treatment for both acute and chronic lung blockages.
Depending upon the type of blockage and its severity, treatment may take the form of medication or surgery.
Pulmonary Embolism: Acute Blockage
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Acute pulmonary blockages extracted from the lung
Blockage extracted from the lung during a pulmonary thromboendarterectomy (PTE) procedure to relieve thromboembolic pulmonary hypertension (CTEPH).
A sudden blockage in the arteries of the lung, known as an acute pulmonary embolism (PE), begins as a clot in a vein elsewhere in the body that travels to the lung. Pulmonary emboli are life threatening, with 25-30% of patients dying unless treated immediately. Acute pulmonary emboli are treated by our pulmonary medicine colleagues with medication to thin the blood or dissolve the clot. For patients at risk for repeat pulmonary emboli, a filter may be placed in the inferior vena cava, the large vein carrying de-oxygenated blood from the lower portion of the body to the heart. In rare cases, medical management of acute pulmonary emboli fails to adequately treat these clots, or a patient may have severe hemodynamic instability from a very large embolus. In these cases, a surgeon can remove the offending clot and restore proper blood flow to the lungs. Columbia surgeons have expertise in all procedures involving pulmonary artery conditions.
Pulmonary Embolism: Chronic Blockage
Ongoing blockage of the pulmonary arteries occurs when clots and other matter from the blood builds up in the vessels, inhibiting or blocking the path of blood flow. The causes of these blockages are multivariate, and many are not well understood, but are thought to include 1) a part of a blockage remaining after the clearing of an acute pulmonary embolism, or 2) a clot remaining from an undetected, and therefore untreated, acute pulmonary embolism.
A chronic pulmonary blockage curtails the flow of blood through the lungs, which receive blood from the right side of the heart and deliver oxygenated blood to the left side of the heart, causing a situation of high blood pressure in the lungs (pulmonary hypertension). The resulting disease state is known as chronic thromboembolic pulmonary hypertension (CTEPH). CTEPH may be mild or severe depending on the position and size of the blockage, which may grow over time.
CTEPH is initially difficult to diagnose because its main symptom in its early stages, shortness of breath, can signify a variety of conditions. As the size of the pulmonary blockage progresses, and the CTEPH increases, additional symptoms may appear due to stress placed on the right side of the heart as it struggles to push blood through the blocked area. As the flow of blood through the lungs is diminished, so is the oxygenation of the blood. Symptoms may include: difficulty breathing, water retention in the limbs (edema) due to the heart's reduced ability to move fluid through the body's blood vessels, chest pain, light-headedness and faintness (syncope).
The physician can diagnose the condition using a series of tools, including an echocardiogram (sound wave picture of the heart) and a pulmonary angiogram, an X-ray image of the pulmonary arteries.
Read about treatments for blockages of the pulmonary arteries.
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