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In the fall of 2004, Ernestine Smith, mother of five and grandmother of nine, began having breathing problems. She underwent numerous tests and started medical treatment but her health continued to decline. Ten months later an angiogram revealed extensive clots lodged in her pulmonary arteries. As she progressively grew worse Smith sensed she did not have long to live.
"I knew I couldn’t live through another year," says the 74-year-old resident of Fredericksberg, Virginia. "The doctors didn’t have to tell me. I knew. Every day it took more and more oxygen to breathe."
Chronic thromboembolic pulmonary disease (CTE) rings an ominous death knoll for most people, with blood clots clogging the network of pulmonary arteries that carry blood from the lungs to the heart. But when diagnosed and treated with a pulmonary thromboendarterectomy (PTE), an intricate surgery to remove the clots, many patients can return to a normal life.
Smith’s pulmonologist referred her to the University of California, San Diego Medical Center. As pioneers and the world’s foremost experts in this procedure, UCSD Medical Center’s pulmonary and cardiothoracic surgery team has successfully treated more patients through its PTE program than any institution in world. Recently the UCSD PTE team performed its 2,000th procedure.
Diagnosis is key, says Stuart Jamieson, M.B., FRCS, chief of UCSD Medical Center’s Division of Cardiothoracic Surgery, though the disease is often misdiagnosed. "Patients with breathing problems are often misdiagnosed with asthma or allergies. It is not until they can barely walk that the real problem is found," he says. "PTE can not only renew but restore their life."
The dominant symptom of CTE is the insidious onset of exertion-related shortness of breath, which doctors unfamiliar with the disease often diagnose as primary pulmonary hypertension, coronary artery disease or exercise-induced asthma. The UCSD PTE team correctly diagnoses the disease through careful analysis of lung scans, combined with other tests.
William Auger, M.D., UCSD Medical Center pulmonary specialist,and Medical Director of the PTE Program said physicians call him every day, to refer patients for CTE evaluation and PTE screening. After reviewing a prospective patient’s history and x-ray studies, Auger determines PTE suitability. If suspected, physicians perform additional tests including the pulmonary angioscope, developed at UCSD, which examines the pulmonary artery’s interior. In the past 20 years, Auger and his UCSD Pulmonary Critical Care colleagues have analyzed over 3,000 people for suspected CTE. According to Auger, the clots are not easily recognizable and detection experience is key.
Smith arrived in San Diego in late April 2006, underwent more tests and finally entered the operating room on May 2. In preparation, Smith told her husband, five daughters and grandson gathered around her bed where to find the funeral service notes she wrote for herself. She couldn’t imagine she would survive. Not only did she survive but the day after surgery Smith sat up in bed and asked for a slice of pizza. She has been recovering swiftly ever since. Smith is getting stronger everyday and figures she won’t be needing her funeral plans for a long time.
"That team saved me," Smith says. "They gave me back my life. Before, I had no hope, I wasn’t going to live and now I’m going to live a very long life."
The 8-to-15 hour PTE procedure involves opening the chest, attaching the patient to a heart-lung bypass machine and cooling the patient’s body to about 73 degrees Fahrenheit. The cold temperature reduces the body’s need for oxygen by 95 percent. Surgeons then turn off the heart-lung machine, stopping circulation for up to 20 minutes, to create a bloodless surgical field. The on-off process is repeated until surgeons remove all of the webbed, clot substance from the pulmonary artery walls. The clots, often more than 10 inches long, frequently appear as casts of the pulmonary arteries.
UCSD Medical Center’s PTE team began performing this unique operation in 1970 and has performed more of these operations than all other PTE programs combined. The team averages two to four operations per week. Only a handful of other medical centers perform PTE.
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Media Contact: Jeffree Itrich
UCSD Health Sciences Communications HealthBeat: News
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Center For Transplantation
William Auger, M.D.
Stuart Jamieson, M.B., FRCS
Official Web Site of the University of California, San Diego.