can also be treated . This is done primarily through a highly complex surgical procedure known as pulmonary thromboendarterectomy , or PTE , which involves connecting the patient to a cardiopulmonary bypass machine , radically cooling the body to stop circulation , and then surgically removing all the clots through an incision in the chest . Pioneered in the 1970s at the University of California , San Diego , the technique has been refined elsewhere over decades . Today , PTE is still available at only a few sites in the country — and the CALC is now one of them .
“ When I first started here , we had to send patients diagnosed with CTEPH elsewhere ,” says Assistant Professor of Medicine Chris Mullin , MD , MHS , a pulmonary and critical care specialist and director of the CTEPH Program . That meant losing significant control over his patients ’ care , he says — not to mention the fact that some patients simply refused to travel . Now they won ’ t have to .
Not all patients are candidates for PTE , however . For those who aren ’ t , the CALC offers another , more recently developed and less invasive procedure , balloon pulmonary angioplasty . During BPA , a thin catheter is threaded through veins to get to the right heart and pulmonary arteries ; a small balloon at the end of the catheter is then inflated , widening blocked passages and improving blood flow . The procedure is repeated several times over many weeks .
But before any of that can happen , a patient must know they have the condition , and CTEPH is underdiagnosed and underrecognized by clinicians , Mullin says . He is eager for pulmonologists and cardiologists in the community to refer patients who are short of breath or not symptomatically recovered after a pulmonary embolism to the CALC . There , he can administer the not-insignificant series of tests and procedures necessary to diagnose the condition , and then determine a treatment plan . He , Ventetuolo , and other physicians regularly review cases together . “ That ’ s the strength of this program ,” Mullin says . “ We can access the expertise of all these different subspecialists to come up with the best treatment plan .”
COOL TOOLS Assistant Professor of Medicine Douglas Martin , MD , an interventional pulmonologist , sees the CALC as a potential “ magnet ”— not just for patients , but also for physicians who ,
Corey Ventetuolo , left , says much progress has been made in treating patients like Jennifer M . with PAH : “ I ’ ve seen people get their lives back .”
like him , want to provide the latest in diagnostic procedures . Martin is excited by the recent acquisition of cutting-edge tools that improve the ways physicians can evaluate spots or shadows on the lungs that have shown up on a chest x-ray or CT scan .
One of these , an endobronchial ultrasound system ( EBUS ), can be threaded down the trachea and into the lungs to explore and biopsy airway-adjacent masses . ( A conventional radiologist , on the other hand , inserts a needle through the chest wall and into the lung , which has the potential to cause bleeding and lung collapse .) In addition , the EBUS can be used to obtain a biopsy of the lymph nodes as well as the masses . Another technology , called navigational bronchoscopy with cone beam CT , uses a catheter synchronized to the patient ’ s CT scan data to provide a three-dimensional image that helps guide a needle with precision into a pulmonary nodule ; the cone beam CT provides a single-slice CT confirmation , allowing a high
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