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Referrals

 What We Do

The Toronto CTEPH Program receives referrals from physicians for patients who have suspected diagnosis of CTEPH. Led by Dr. de Perrot​, the program offers multidisciplinary assessment by the surgeons and respirologists who have expertise in the field of pulmonary hypertension.

Being the largest Canadian centre for the pulmonary thromboendarterectomy (PEA) surgery, the program receives referrals from across the country. Our program is involved in:

  • Evaluation of acute and chronic thromboembolic disease
  • Education of patients and families about chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary thromboendarterectomy (PEA)
  • Surgical management of CTEPH through PEA 
  • Interventional radiology management of CTEPH through Balloon Pulmonary Angioplasty (BPA)
  • Increasing public and medical community awareness about CTEPH diagnosis and curative surgical treatment
  • Clinical research​​

Who should be referred to the CTEPH center?

All patients with the history of pulmonary emboli who remain symptomatic with dyspnea despite 3 months of therapeutic anticoagulation should undergo a ventilation-perfusion scan (V/Q scan). If the ventilation-perfusion scan shows mismatched perfusion defects, patients should be referred to our center for definitive evaluation and treatment.

Considering that a proportion of patients with CTEPH do not have a history of pulmonary emboli, the presence of dyspnea with mismatch perfusion defects on V/Q scan should also warrant referral to our center for evaluate the possibility of CTEPH.

What is CTEPH?

CTEPH is a type of pulmonary hypertension that is caused by the unresolved or recurrent pulmonary emboli leading to chronic pulmonary vascular obstruction by an organized clot. The disease progresses despite adequate anticoagulation as a result of secondary arteriopathy eventually leading to the right heart failure and death. Recognition of CTEPH in patients with history of pulmonary emboli is important to achieve timely diagnosis and appropriate follow up/referral.

Patients with CTEPH can present with acute pulmonary emboli. CTEPH should be suspected in the presence of:

  • Idiopathic and/or recurrent pulmonary emboli
  • Longer time between symptom onset and diagnosis
  • Right ventricular systolic pressure > 50 mmHg on echocardiogram
  • Large perfusion defects, mosaic parenchymal changes, and/or arterial webs or bands on CT Pulmonary Angiogram​

Treatment for CTEPH

Pulmonary thromboendarterectomy is the treatment of choice for CTEPH. The PEA surgery leads to major clinical improvements due to improved hemodynamic parameters and oxygenation, and reduction in dead space ventilation. The surgery can be also curative in the large number of patients with resolution of the pulmonary hypertension. Majority of the patients experience significant functional recovery and are able to return to their baseline physical activity level without supplemental oxygen use.

If PEA surgery is not right for the patient, the CTEPH team will assess the patient to find other treatment options that may include:

  1. Pulmonary hypertension medication Riociguat®
  2. Balloon Pulmonary Angioplasty (BPA) – an investigational procedure that is done by an interventional radiologist at the Toronto General Hospital to dilate pulmonary arteries that are obstructed by the chronic scar tissue.

More information for physicians can be found here​.

How to Prepare

First appointments can take 2 hours or more. During the first appointment, you will meet several health professionals who will do a detailed assessment of your health. You may also have some investigations on the same day before your clinic visit. Follow-up appointments usually take 30 to ​45 minutes.

Learn more about what you can expect when you have a clinic appointment.

 Materials and Resources to Help You

Resources from the Patient & Family Education Program PDF Icon

* These material(s) are also available in other languages.

 Meet Our Team

​Program Director: Dr. Marc de Perrot

Thoracic Surgeon: Dr. Laura Donahoe

Nurse Practitioner: Anastasia Bykova

Clinical Coordinator:  Jennifer Monroy ​

Clinic Nurse Educator:  Marilena Rutka

Associated Specialists