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Chronic Thromboembolic Pulmonary Hypertension (CTEPH) - Referrals

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​​​​​ Physician referrals for out-patients

Physicians can call the Toronto CTEPH Program office at 416 340 4800 ext. 5274 to request a referral. This must be followed up by a faxed referral with the patient's demographics and copies of their clinical notes and test results if the following have been performed: V/Q scan, CT scan, echocardiogram, pulmonary function tests, and 6-minute walk test. The patient will need to bring a CD with all pertinent imaging on it.

Physician referrals for in-patients

Physicians can contact Dr. de Perrot or Anastasia Bykova, Nurse Practitioner, directly by paging them through locating. They can also call Susan Beaudoin in the CTEPH office at 416 340 4800 ext. 5549. If the patient needs to be transferred to the Toronto General Hospital, this must be a doctor-to-doctor agreement.

Sending the referral documents

The referral can be faxed to our office at 416 340 3610 or sent by courier to: Susan Beaudoin, Clinical CTEPH Coordinator, 9N921, Division of Thoracic Surgery, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON M5G 2C4

Important: Physicians, please ensure to include patient's demographics and your billing number​

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​.

​Resources for Physicians

More Referral Links

Go to the Chronic Thromboembolic Pulmonary Hypertension (CTEPH)​