Facilitated Pulmonary Thromboendarterectomy on the Left Side Through Cardiac Dislocation

Abstract

Optimal visualization of the distal branches during pulmonary endarterectomy (PEA) is essential for the complete removal of organized thromboembolic material in patients with chronic thromboembolic pulmonary hypertension. Often, a left-sided endarterectomy is compromised because of poor visualization of the lower lobe branches. We developed a modification of the originally described technique that improves surgical exposure for PEA. During the procedure, the heart is rotated toward the right pleural cavity. Better visualization is achieved by elevating tension on the posterolateral wall of the left pulmonary artery owing to the heart dislocation. Our method improves visualization of the left lower lobe branches during PEA. This manoeuver can be easily performed and may reduce the length of the circulatory arrest.