After visiting the emergency room with fainting spells and shortness of breath, a 17-year-old Morningside Heights boy was diagnosed with rare, life-threatening blood clots blocking his pulmonary arteries. To address the problem, surgeons at NewYork-Presbyterian Hospital Morgan Stanley Children's Hospital successfully performed a pulmonary thromboendartectomy (PTE) surgery -- reportedly, the first time it has been performed on a child in the New York City area.
In the complex, eight-hour open procedure, surgeons stopped the patient's heart, hooked him up to a heart-lung bypass pump, and cooled him to 18 degrees Celsius, or 64 degrees Fahrenheit, in order to reduce his body's need for oxygen. They then opened his pulmonary artery, shut off the bypass pump in order to eliminate blood flow, and removed several large branching clots. The process was repeated for each artery.
Leading the surgery was Dr. Matthew Bacchetta, a thoracic surgeon at NewYork-Presbyterian Morgan Stanley Children's Hospital and NewYork-Presbyterian Hospital/Columbia University Medical Center; and assistant professor of surgery at Columbia University College of Physicians and Surgeons. Dr. Bacchetta learned the technique of PTE surgery at the University of California at San Diego (UCSD), where it was developed.
"Before the surgery, this patient could barely walk across the room, and because he couldn't effectively oxygenate his blood, he was at risk of heart failure. Today he is walking around without oxygen, and his long-term prospects are excellent," says Dr. Bacchetta. "Because he may be at risk for other blood clotting, he is taking blood thinners and will be closely monitored."
PTE is an attractive alternative to lung transplantation, notes Dr. Bacchetta, who also performs lung transplants. "With transplantation, patients must wait for an organ, and then once the transplant occurs, they require lifelong treatment with immunosuppressant drugs. Also, PTE is associated with better long-term survival."