Birth of the Modern Era of CTEPH Diagnosis and Care

William R. Auger

https://doi.org/10.1002/pul2.70187

It was a Sunday morning. That was the only time Drs. Pat Daily or Walt Dembitsky could review cases before they operated on Monday. It was 1986, and I was a pulmonary fellow, so my presence at this meeting with Dr. Kenneth Moser (1929–1997) (Figure 1) was as an observer, not a participant. At this meeting, we discussed the history of a middle-aged man who had experienced years of declining health. He had been labelled with various cardiopulmonary diagnoses, but none of the prescribed treatments seemed to help. An echocardiogram was eventually obtained, which showed enlargement of the right ventricle. When a carefully solicited history revealed that he had experienced a pulmonary embolus, the puzzle pieces fell into place. They led to a seldom diagnosed disease called chronic thromboembolic pulmonary hypertension (CTEPH).

I knew nothing about CTEPH and soon I realized that I wasn't alone given the state-of-the-art in the mid-1980s. At that time, the worldwide clinical experience with CTEPH was very limited. CTEPH was rarely reported, the mortality rate was high, and pulmonary thromboendarterectomy (PTE) was considered by many to be “experimental” or “a last resort” [1].

I watched Dr. Moser and Dr. Daily review cut films of a pulmonary angiogram, carefully examining each vessel for signs of organized thrombus. It wasn't only about the diagnosis but also about determining if the surgeon could remove the clots. After an extended discussion, they concluded that PTE was possible, and without other options, they would offer this man an operation that seemed unimaginable. The patient and his family understood that the surgery was risky, and the postoperative course would likely be challenging. The whole thing seemed terrifying, yet hopeful at the same time.

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