“From Struggle to Breathe to Freedom to Live”: The Miracle of Pulmonary Thromboendarterectomy

Pavithra. D1, Ramya Bharathi. G2, Raveena. D3, Sabari Divya Nandini. R4

1Registered Nurse, Heart and Lung Transplant ICU, Kauvery Hospital, Vadapalani, Tamil Nadu

2Registered Nurse, Heart & Lung Transplant ICU, Kauvery Hospital, Vadapalani, Tamil Nadu

3Registered Nurse CTICU, Kauvery Hospital, Vadapalani, Tamil Nadu

4Nurse Educator, Kauvery Hospital, Vadapalani, Tamil Nadu

Abstract

A 26-year-old male presented to Kauvery Hospital, Vadapalani on February 13, 2025, with a complex medical history notable for left femoropopliteal Deep Vein Thrombosis (DVT) since 2018, chronic pulmonary thromboembolism since 2018, severe pulmonary artery hypertension complicated by right heart failure, severe tricuspid regurgitation, and antiphospholipid syndrome. He had good left ventricular function. He was scheduled to undergo pulmonary thromboendarterectomy (PTE) surgery.

Introduction 

Pulmonary thromboendarterectomy (PTE) is the treatment of choice for relieving pulmonary artery obstruction in patients with chronic thromboembolic pulmonary hypertension (CTEPH). This surgical procedure involves removing old blood clots and scar tissue from the pulmonary arteries, which carry blood to the lungs.

Antiphospholipid syndrome (APS) is an autoimmune disorder in which the immune system mistakenly attacks normal proteins in the blood. This can lead to the formation of blood clots in arteries, veins, and organs, as well as increase the risk of miscarriage and stillbirth in pregnant women.

Pulmonary thromboendarterectomy is a specialized surgical procedure that aims to improve blood flow to the lungs and alleviate symptoms of CTEPH.

Brief Clinical History

In 2018, the patient experienced dizziness and syncope while walking, prompting evaluation at outside Hospital. He was diagnosed with pulmonary thromboembolism and treated with thrombolytic injections, followed by conservative management and medical treatment.

In 2022, the patient developed sudden onset of breathlessness and left leg swelling, leading to evaluation at outside Hospital. The diagnosis revealed chronic pulmonary embolism, severe pulmonary artery hypertension, and antiphospholipid syndrome. After medical stabilization, he was discharged.

The patient then sought a second opinion at another Hospital, where pulmonary thromboendarterectomy was recommended. He was subsequently referred to Kauvery Hospital, Vadapalani, for further management.

Case History

  • History of bilateral extremity deep vein thrombosis (DVT) since 2018.
  • Dyspnea (shortness of breath) and fatigue for six years
  • Changes in voice quality for two years
  • Breathlessness on exertion associated with palpitations for six years
  • Cough following liquid intake

Diagnosis

  • Chronic pulmonary thromboembolism
  • Severe pulmonary artery hypertension with right heart failure
  • Severe tricuspid regurgitation
  • Antiphospholipid antibody syndrome

Surgical Intervention

Pulmonary thromboendarterectomy (PTE) was performed on March 3, 2025.

Postoperative Nursing Management

The patient was transferred from the Cardiothoracic Operating Theater (CTOT) to the Cardiothoracic Intensive Care Unit (CTICU) with ventilator support and high-dose of Inotropes. Continuous cardiac monitoring and cardiac output management were implemented to evaluate heart failure.

On the first postoperative day (POD), the patient remained on ventilator support. Suddenly, involuntary movements were observed, and the doctors and neurologist were alerted. Anti-epileptics were started prophylactically. Emotional support was provided to the patient to gain cooperation and maintain nutritional status.

On POD 2, continuous ventilator support, antibiotic infusion, and suctioning were continued. Back care, oral care, and personal hygiene were done.

There was no bleeding from the drain for six hours, and the drain was removed. Chest physiotherapy, active and passive exercises, and incentive spirometry were encouraged.

By POD 3, ventilator support was weaned, and blood gas results were satisfactory. The patient was extubated and placed on oxygen support.

On POD 4, the patient’s cardiac and neurological conditions improved, with no further episodes of seizures. Anti-epileptics were continued.

The patient was shifted to the ward with oxygen support, hemodynamically stable. Physiotherapists helped the patient ambulate outside the room.

Before discharge, the patient received education on:

  • Medication importance
  • Personal hygiene
  • Breathing exercises (from physiotherapist)
  • Meal pattern and protein-rich diet (from dietician)
  • Avoid weight lifting and driving
  • Fluid restriction (2 liters per day)

The patient was discharged in a stable clinical status.

Conclusion

The patient’s successful management of chronic pulmonary thromboembolism, severe pulmonary artery hypertension, and antiphospholipid antibody syndrome highlights the importance of a multidisciplinary approach to care. The collaboration between Cardiothoracic surgeons, Intensivists, Neurologists, Physiotherapists, and Nurses ensured optimal postoperative management and rehabilitation.

The patient’s recovery demonstrates the effectiveness of pulmonary thromboendarterectomy in improving cardiac function and reducing symptoms. Moreover, the prompt recognition and management of postoperative complications, such as seizures, underscore the importance of vigilant monitoring and timely intervention.

This case study emphasizes the need for comprehensive care, close monitoring, and a patient-centered approach to achieve optimal outcomes in patients with complex cardiovascular conditions.

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