Surgical/operative procedure: pulmonary endarterectomy (PEA)
Surgical therapy presumes, besides suitability for anesthesia, a certain clotting in the pulmonary artery. During the operation, the thorax is opened under full anesthesia and the pulmonary artery exposed. The heart and lung functions are taken over temporarily by a heart-lung machine. The clots in the pulmonary artery are then scraped out of the interior of the vessel. This is followed by 1-2 days’ observation in intensive care. The PEA is carried out in only a few centers worldwide. In Germany, about 200 patients undergo this operation each year. If the operation and consequential hemodilution are successful, PEA is a healing therapy.

Medical procedure
It is the aim of the medical therapy to achieve dilation of the pulmonary arteries in order to thus lower the flow resistance into the pulmonary arteries. This leads to relief of the heart and an improvement in physical resilience. Medication must be taken permanently, since curing the disease with this treatment is not possible.

Interventional procedure (balloon angioplasty of the pulmonary arteries)
Balloon angioplasty of the pulmonary arteries (BPA) is a minimally invasive catheter-assisted treatment with access via a blood vessel (usually in the groin) with a local anesthetic. Under X-ray control, constricted pulmonary arteries are dilated with a thin balloon, to allow the blood to flow more freely into the lung. As the remnants of the clot often form ribbon-like structures in the pulmonary arteries, they are particularly accessible in the balloon angioplasty and cutting these ribbons already leads to a marked improvement of the blood flow in the pulmonary arteries.

The interventional therapy of CTEPH is relatively new. Previous results in clinical use with patients who cannot be operated are, however, excellent. In order to avoid any complications, normally only a few lung vessels are treated in one „sitting“. For complete therapy, 3-4 sittings will usually be required, to be carried out at about 4-week intervals.