Chronic thromboembolic pulmonary hypertension after pulmonary embolism, thrombolysis, catheter fragmentation, and embolectomy.

A 21-year-old male patient with massive acute pulmonary embolism was treated by thrombolysis, interventional thrombus fragmentation, and surgical pulmonary embolectomy. Within the following 2 years, the patient developed progressive dyspnea at exertion. Chronic thromboembolic pulmonary hypertension was diagnosed by right-heart catheter, VQ scan, magnetic resonance, and conventional pulmonary angiography. A normalization of the patient's exercise capacity and pulmonary hemodynamics could be achieved by pulmonary endarterectomy and patch reconstruction of the right main pulmonary artery.