Figure 1.
Intraoperative set-up for pulmonary endarterectomy. Please note that initially the surgeon stands on the left side of the patient. The left atrial vent is placed via the right superior pulmonary artery and directed into the left ventricle while the patient is cooling and the heart fibrillating. SVC: superior vena cava; IVC: inferior vena cava; PA: pulmonary artery; LA: left atrial.
Figure 2.
Surgical approach to the right pulmonary artery (PA) and endarterectomy. Please note that the right PA is approached between the aorta and superior vena cava (SVC) and not lateral to the SVC.
Figure 3.
The plane of dissection is raised posteriorly initially and then a complete endarterectomy is performed.
Figure 4.
Surgical approach to the left pulmonary artery. The heart is retracted medially using a net-like retractor and the left pulmonary artery is exposed.
Figure 5.
University of California, San Diego classification of pulmonary endarterectomy disease levels. This figure illustrates typical surgical specimens classified based on the most proximal level of obstruction, levels I to IV.
Figure 6.
Instruments used during pulmonary endarterectomy (PEA). (A) 1-mm tip and (B) 2.5-mm tip double action PTE forceps; (C) PEA suction/dissector; (D) small pledget/mini-nut for fine dissection; (E) microendarterectomy spatula for identification of the correct plane; (F) modified cerebellar retractor for exposure of the right pulmonary artery. PTE: pulmonary thromboendarterectomy.