Illustration of lungs transitioning from blocked to clear, symbolizing improved perfusion after PTE.

Clearing the Airways: How Improved Perfusion Scoring is Revolutionizing Pulmonary Thromboendarterectomy

Q: What is pulmonary thromboendarterectomy (PTE) and why is it performed?

Pulmonary thromboendarterectomy, or PTE, is a surgical procedure performed to treat chronic thromboembolic pulmonary hypertension, also known as CTEPH. In CTEPH, blood clots obstruct the pulmonary arteries, which increases pressure and strain on the right side of the heart. PTE involves the physical removal of these clots to restore blood flow and reduce pulmonary hypertension. The success of PTE depends on how well blood flow (perfusion) is restored to the lungs after surgery.

Q: How did the researchers in the ACC.18 study evaluate perfusion improvement after pulmonary thromboendarterectomy (PTE)?

The study presented at ACC.18 used ventilation/perfusion (VQ) scans before and after PTE to evaluate blood flow in the lungs. These VQ scans used planar and SPECT/CT techniques to create detailed images of lung perfusion. Researchers then used a perfusion scoring system to quantify the degree of blood flow in different lung segments, evaluating each segment across multiple projections, with deficits graded on a scale. Clinical and hemodynamic data were collected to compare pre- and post-PTE results, measuring metrics such as NYHA Functional Class, Cardiac Index, Pulmonary Vascular Resistance, and Right Ventricle Function.

Q: In the ACC.18 study, what differences were observed between the 'early' and 'late' VQ scan groups after pulmonary thromboendarterectomy (PTE)?

The study divided patients into two groups based on when they received the post-PTE VQ scan: an 'early' VQ group (scan at 1 week) and a 'late' VQ group (scan at 3 months). While both groups showed improvement in perfusion scores, the 'late' VQ group had a more significant increase. Importantly, improvements in clinical and hemodynamic parameters were similar in both groups, suggesting that perfusion continues to improve over time, even beyond the first week post-surgery. The results highlight the importance of longer-term monitoring to fully assess the benefits of PTE.

Q: What specific clinical and hemodynamic improvements were observed in patients with enhanced perfusion scoring after pulmonary thromboendarterectomy (PTE)?

Improvements in perfusion scoring after PTE are associated with improvements in several key clinical and hemodynamic parameters. For example, patients saw improvement in NYHA Functional Class, indicating reduced symptoms and better exercise capacity. Their Cardiac Index increased, reflecting improved heart function and cardiac output. Pulmonary Vascular Resistance decreased significantly, demonstrating reduced pressure in the pulmonary arteries. Additionally, right ventricle function improved, as indicated by the ratio of right ventricle to left ventricle size and the right ventricular fractional area change.

Q: What are the potential implications of using perfusion scoring to assess the effectiveness of pulmonary thromboendarterectomy (PTE) and what further research could be conducted?

This study demonstrates how perfusion scoring can be a valuable tool in assessing the effectiveness of PTE. By quantifying improvements in blood flow to the lungs, clinicians gain a more objective understanding of the surgery's success. This allows for tailoring post-operative management strategies and provides a basis for further research into optimizing PTE outcomes. Future research could investigate the optimal timing for VQ scans, refine the perfusion scoring system, and explore additional interventions to maximize perfusion improvement after PTE. The study supports the role of perfusion scoring in clinical practice, but more research is needed to fully realize its potential.

Beau Callahan in Health & Wellness December 2025 • 5 min read.

"Discover how a novel method of perfusion scoring after pulmonary thromboendarterectomy (PTE) is leading to better outcomes for patients, improving hemodynamic and right heart function."

Pulmonary thromboendarterectomy (PTE) is a critical surgical procedure for patients suffering from chronic thromboembolic pulmonary hypertension (CTEPH), where blood clots obstruct pulmonary arteries, leading to increased pressure and strain on the heart. The success of PTE hinges not only on the physical removal of these clots but also on the subsequent improvement in blood flow, or perfusion, to the affected lung segments.

A study presented at the American College of Cardiology's 67th Annual Scientific Session (ACC.18) explored a novel method for evaluating perfusion improvement after PTE. This research highlights the correlation between enhanced perfusion scoring and tangible improvements in patients' clinical condition, hemodynamic parameters, and right heart function.

This article will delve into the methods and findings of this study, explaining how this perfusion scoring technique can optimize post-PTE management and contribute to better patient outcomes. We'll break down the complexities of the research in an accessible way, focusing on what it means for those affected by CTEPH and the healthcare professionals who treat them.

Unlocking the Science: Perfusion Scoring and PTE Outcomes

Illustration of lungs transitioning from blocked to clear, symbolizing improved perfusion after PTE.

The study, led by researchers from Temple University Hospital and Weill Cornell Medical Center, involved 37 patients who underwent PTE. These patients underwent ventilation/perfusion (VQ) scans before and after the surgery to assess blood flow in the lungs. The VQ scans were conducted using planar and SPECT/CT techniques, providing detailed images of lung perfusion.

A perfusion scoring system was used to quantify the degree of blood flow in different lung segments. Each segment was evaluated across multiple projections, with a total possible score of 68. Deficits in perfusion were graded as severe (1), moderate (2), mild (3), or none (4). Clinical and hemodynamic data were collected to compare pre- and post-PTE results.

NYHA Functional Class: Improved from 3±1 to 2±1 (p<0.05), indicating reduced symptoms and better exercise capacity.
Cardiac Index: Increased from 2.1±0.6 to 2.8±0.5 L/min/m² (p<0.05), reflecting improved heart function and cardiac output.
Pulmonary Vascular Resistance: Decreased significantly from 8.5±5.3 to 2.2±1.1 mmHg/L/min (p<0.05), demonstrating reduced pressure in the pulmonary arteries.
Right Ventricle Function: The ratio of right ventricle to left ventricle size improved from 1.1±0.3 to 0.9±0.2 (p<0.05), and the right ventricular fractional area change increased from 28±14% to 46±11% (p<0.05), indicating enhanced right heart performance.

The researchers divided the patients into two groups based on when the post-PTE VQ scan was performed: a 'late' VQ group (30 patients, scan at 3 months) and an 'early' VQ group (7 patients, scan at 1 week). The late VQ group showed a significant improvement in perfusion scores (43±7 to 55±7, p<0.05). While the early VQ group also showed improvement, it was not as significant (55±7 vs 50±8, p=0.06). Notably, improvements in clinical and hemodynamic parameters were similar in both groups, suggesting that perfusion continues to improve over time.

The Future of PTE: Optimizing Perfusion Assessment

This study underscores the importance of perfusion scoring as a valuable tool in assessing the effectiveness of PTE. By quantifying the improvement in blood flow to the lungs, clinicians can gain a more objective understanding of the surgery's success and tailor post-operative management accordingly.

The research suggests that assessing perfusion at three months post-PTE provides a reliable indicator of long-term outcomes. Further studies could explore the optimal timing for perfusion assessment and investigate the relationship between perfusion scores and other clinical markers.

For patients with CTEPH, this research offers hope for improved outcomes and a better quality of life. By optimizing perfusion assessment and tailoring treatment strategies, healthcare professionals can continue to refine the PTE procedure and enhance the well-being of those affected by this challenging condition.

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This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/s0735-1097(18)32239-3, Alternate LINK

Title: Improvement In Perfusion Scoring After Pulmonary Thromboendarterectomy Correlates With Improvement In Clinical: Hemodynamic And Right Heart Function

Subject: Cardiology and Cardiovascular Medicine

Journal: Journal of the American College of Cardiology

Publisher: Elsevier BV

Authors: Farhan Raza, Anjali Vaidya, Chandra Dass, Paul Forfia, Simin Dadparvar

Published: 2018-03-01

Everything You Need To Know

What is pulmonary thromboendarterectomy (PTE) and why is it performed?

Pulmonary thromboendarterectomy, or PTE, is a surgical procedure performed to treat chronic thromboembolic pulmonary hypertension, also known as CTEPH. In CTEPH, blood clots obstruct the pulmonary arteries, which increases pressure and strain on the right side of the heart. PTE involves the physical removal of these clots to restore blood flow and reduce pulmonary hypertension. The success of PTE depends on how well blood flow (perfusion) is restored to the lungs after surgery.

How did the researchers in the ACC.18 study evaluate perfusion improvement after pulmonary thromboendarterectomy (PTE)?

The study presented at ACC.18 used ventilation/perfusion (VQ) scans before and after PTE to evaluate blood flow in the lungs. These VQ scans used planar and SPECT/CT techniques to create detailed images of lung perfusion. Researchers then used a perfusion scoring system to quantify the degree of blood flow in different lung segments, evaluating each segment across multiple projections, with deficits graded on a scale. Clinical and hemodynamic data were collected to compare pre- and post-PTE results, measuring metrics such as NYHA Functional Class, Cardiac Index, Pulmonary Vascular Resistance, and Right Ventricle Function.

In the ACC.18 study, what differences were observed between the 'early' and 'late' VQ scan groups after pulmonary thromboendarterectomy (PTE)?

The study divided patients into two groups based on when they received the post-PTE VQ scan: an 'early' VQ group (scan at 1 week) and a 'late' VQ group (scan at 3 months). While both groups showed improvement in perfusion scores, the 'late' VQ group had a more significant increase. Importantly, improvements in clinical and hemodynamic parameters were similar in both groups, suggesting that perfusion continues to improve over time, even beyond the first week post-surgery. The results highlight the importance of longer-term monitoring to fully assess the benefits of PTE.

What specific clinical and hemodynamic improvements were observed in patients with enhanced perfusion scoring after pulmonary thromboendarterectomy (PTE)?

Improvements in perfusion scoring after PTE are associated with improvements in several key clinical and hemodynamic parameters. For example, patients saw improvement in NYHA Functional Class, indicating reduced symptoms and better exercise capacity. Their Cardiac Index increased, reflecting improved heart function and cardiac output. Pulmonary Vascular Resistance decreased significantly, demonstrating reduced pressure in the pulmonary arteries. Additionally, right ventricle function improved, as indicated by the ratio of right ventricle to left ventricle size and the right ventricular fractional area change.

What are the potential implications of using perfusion scoring to assess the effectiveness of pulmonary thromboendarterectomy (PTE) and what further research could be conducted?

This study demonstrates how perfusion scoring can be a valuable tool in assessing the effectiveness of PTE. By quantifying improvements in blood flow to the lungs, clinicians gain a more objective understanding of the surgery's success. This allows for tailoring post-operative management strategies and provides a basis for further research into optimizing PTE outcomes. Future research could investigate the optimal timing for VQ scans, refine the perfusion scoring system, and explore additional interventions to maximize perfusion improvement after PTE. The study supports the role of perfusion scoring in clinical practice, but more research is needed to fully realize its potential.