The expanding role of intraoperative transesophageal echocardiography in pulmonary endarterectomy for CTEPH.

Chronic thromboembolic pulmonary hypertension (CTEPH) results from persistent pulmonary artery thromboembolism (PTE). This leads to elevated pulmonary pressure and right ventricular dysfunction. While pulmonary endarterectomy is the primary treatment, identifying and managing extrapulmonary thrombi, particularly in the inferior vena cava (IVC), are crucial for optimal outcomes. Preoperative imaging, including ventilation-perfusion (V/Q) scanning, echocardiography, and computed tomography pulmonary angiography (CTPA), may fail to detect these thrombi. Intraoperative transesophageal echocardiography (TEE) plays a crucial role in identifying occult thrombi, guiding surgical decisions, and preventing embolisation. We present a 38-year-old woman with extensive PTE, where intraoperative TEE altered the surgical approach, ensuring complete thrombectomy and improving patient safety.