What is the role of surgery in the treatment of cor pulmonale?

Updated: Dec 15, 2017
  • Author: Derek Leong, MD; Chief Editor: Henry H Ooi, MD, MRCPI  more...
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Phlebotomy is indicated in patients with chronic cor pulmonale and chronic hypoxia causing severe polycythemia, defined as hematocrit of 65% or more. Phlebotomy results in a decrease in mean pulmonary artery pressure, a decrease in mean pulmonary vascular resistance, [44] and an improvement in exercise performance in such patients. However, no evidence suggests improvement in survival.

Generally, phlebotomy should be reserved as an adjunctive therapy for patients with acute decompensation of cor pulmonale and patients who remain significantly polycythemic despite appropriate long-term oxygen therapy. Replacement of the acute volume loss with a saline infusion may be necessary to avoid important decreases in systemic blood pressure.

Uvulopalatopharyngoplasty (UPPP) in selected patients with sleep apnea and hypoventilation may relieve cor pulmonale. [45]

Pulmonary embolectomy is indicated in patients with acute pulmonary embolism and hemodynamic instability when thrombolytic therapy is contraindicated. Catheter-directed embolectomy can be accomplished with a variety of modalities, including suction embolectomy, rotational embolectomy, and rheolytic embolectomy, which involves the injection of pressured saline and concurrent aspiration of the macerated thrombus. 

Surgical embolectomy may be also be indicated in similar patients or in patients whose previous thrombolytic therapy failed, particularly if the location of the thrombus is in a more proximal location. 

Single-lung, double-lung, and heart-lung transplantation are all used to salvage the terminal phases of several diseases (eg, PPH, emphysema, idiopathic pulmonary fibrosis, cystic fibrosis) complicated by cor pulmonale. Lung transplantation may lead to a reversal of right ventricular dysfunction from the chronic stress of pulmonary hypertension. However, strict selection criteria for lung transplant recipients must be met because of the limited availability of organ donors

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