When Resources Define Operability After Pulmonary Endarterectomy
Year: 2026
Type: editorial
Abstract: A recurrent pulmonary embolism after pulmo- nary endarterectomy is never a simple recurrence.It forces clinicians to ask whether they are facing a new acute thromboembolic event, residual or progressive chronic thromboembolic pulmonary disease, recurrent chronic thromboembolic pulmonary hypertension (CTEPH), or a combination of these processes.In the accompanying case in this issue of JACC: Case Reports, Batool et al 1 describe a young patient with previous pulmonary endarterectomy, hyperhomocysteinemia, recurrent pulmonary embolism while receiving rivaroxaban, right ventricular dysfunction, and limited access to invasive hemodynamics, catheter-based therapies, and advanced cardiopulmonary support.The report is important not because it offers a definitive solution, but because it exposes a frequent and underdiscussed problem: in pulmonary vascular disease, the boundary between inoperability and nondeliverability is often drawn by the system around the patient.The first lesson is diagnostic.The authors appropriately acknowledge that CTEPH could not be confirmed because right heart catheterization was unavailable.Echocardiography suggested elevated right-sided pressures and right ventricular dysfunction, but noninvasive imaging cannot replace invasive hemodynamic confirmation when CTEPH is suspected.2 This distinction matters.Acute recurrent pulmonary embolism, residual chronic obstruction after pulmonary endarterectomy, and CTEPH share symptoms, imaging abnormalities, and right ventricular consequences, yet they drive different therapeutic pathways.In this patient, a new proximal filling defect and subsequent radiographic improvement after thrombolysis support an important acute component, whereas previous endarterectomy, reduced right lung volume, and suspected pulmonary hypertension raise concern for chronic disease.
Source: JACC Case Reports
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $850
OpenAlex ID: W7204272107