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Figure 1. Diagnosing CTEPH and Surgical Assessment after unresolved PE15
Prior PE without resolution of
symptoms after ≥3 months of
anticoagulation
V/Q scan
C LO T S D E T E C T E D
N O C LO T S D E T E C T E D
RHC to confirm
CTEPH mPAP ≥25 mmHg
PCWP ≤15 mmHg
CTEPH excluded;
continue workup consistent
with symptoms
Selective pulmonary angiography,
CTPA, magnetic resonance
angiography to confirm presence
and location of lesions
Surgical assessment,
including accessibility of lesions,
comorbidities, hemodynamics
Eligible: Proceed with PTE
Patients who have operable CTEPH should be
referred for surgery without delay.15 Though all CTEPH
patients require lifelong anticoagulation to prevent in
situ pulmonary artery thrombosis and recurrent venous
thromboembolism,15,24 anticoagulation is not sufficient
to treat the progressive right ventricular dysfunction that
results from CT A