Technique helped treat patient’s rare pulmonary disorderSep. 10, 2020, 9:31 AM
by Matt Batcheldor
Sourav Panja, PhD, a postdoctoral scholar in the Department of Pediatrics at Vanderbilt University Medical Center, was working in his lab one evening last year when he began coughing up blood. Even breathing was becoming difficult.
Panja’s wife, Chitra Basu, a postdoctoral scholar in the Department of Cardiovascular Medicine at VUMC, called 911 and he was quickly transported to Vanderbilt’s Emergency Department.
Panja was suffering from a relatively rare form of pulmonary hypertension called chronic thromboembolic pulmonary hypertension (CTEPH). His symptoms were caused by high blood pressure in the arteries of his lungs due to chronic blood clots and related scarring, which can lead to heart failure and death if untreated.
He learned that VUMC is one of a few centers in the country — and the only one in the Southeast — that offers a surgery that can cure the condition, called a pulmonary thromboendarterectomy. About two weeks after his visit to the emergency department, he underwent the procedure and later returned to work.
“I am feeling a lot better,” Panja said. “I don’t feel any breathing trouble. Now I can do my daily work (exercise, weightlifting, running etc.) like a normal person. I think this surgery helped cure me from pulmonary hypertension. It has also relieved me from taking many hypertension-related medicines. Now, I am only taking a blood thinner and a low dose of blood pressure medicine.”
Panja’s care team included pulmonologist Ivan Robbins, MD, professor of Medicine, and Matthew Bacchetta, MD, MBA, associate professor of Thoracic Surgery, who performed the surgery.
Ashish Shah, MD, professor and chair of Cardiac Surgery, also performs the procedure, making VUMC one of very few centers that has two surgeons capable of the specialized surgery.
“We take this notion of being a national leader in surgical approaches to pulmonary hypertension very seriously,” Shah said. “We have built a multidisciplinary team that includes pulmonologists, cardiologists, radiologists and surgeons to successfully offer a complex procedure to vulnerable and critically ill patients. The results have been gratifying, to say the least.”
The complex procedure consists of delicately removing blood clots in the arteries of the lungs. The patient is cooled and their entire blood volume is drained, rendering them bloodless in a state of metabolic hibernation — all to allow the delicate work — but only for a short period of time. The chest is opened via median sternotomy.
“Within a very short period of time after recovering from the surgery, these patients feel dramatically better and can really return to normal activities,” Bacchetta said.
“This is an intervention that can really just have a dramatic impact on the quality of life for patients who have this type of disease.”
As a Regional Center of Excellence, VUMC receives patient referrals for the procedure from throughout the Southeast, about 40 a year, Robbins said. VUMC has been performing the surgery for more than a decade.
Panja, 31, was fortunate to have his condition diagnosed early. Many patients live with the condition for years because it is diagnosed as another form of pulmonary hypertension, Robbins said.
“Unfortunately, a lot of these people come to our attention late,” Robbins said. “We’ve tried to do a lot of educational efforts to bring light to this and to let cardiologists and pulmonologists, who see the majority of these people, know that this can happen and that the changes you are looking for are different. This should be on your radar.”
Bacchetta said that awareness of the condition is increasing, particularly over the last couple of years.
“Identified at the right time, patients do not have a lasting impact from having exposure to the disease prior to being treated,” he said. “In other words, all their other organs remain highly functional and they never suffer any of the sequela of having chronic exposure to the disease.”
Panja was very complimentary of his experience at Vanderbilt.
“I felt heard and cared for and left feeling very satisfied,” he said. “It is an excellent and well-managed service.”