Who should be referred to us?

  • All patients with a 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 undergo a right-sided focus echocardiogram and 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 further evaluation.
  • To refer your patient to the CTEPH program, please include:
    1. A letter of referral
    2. Clinical notes
    3. Reports of investigations (V/Q scan, CT thorax, echocardiogram, etc.)
  • Please fax referrals to 416 340 3610

Minimum requirements (must be complete prior to sending referral)

  • Detailed Medical Consult Note (complete patient demographics)
  • Current Medications (anticoagulation)
  • V/Q Scan
  • Echocardiogram (within the last 6 months)

If possible, include

  • CTPA Scan
  • Pulmonary Function testing (within the last 6 months)
  • 6-minute Walk test (within 3 months)

In addition, also include

  • Right Heart Angiogram (+ Left Heart Angiogram if >40 years)
  • All CD copies of imaging (CT, angiogram, V/Q scan, etc.), mailed to our office

Next Steps

New referrals are usually seen in 2-4 weeks. The patient will be contacted directly with their appointment time. Patients from other provinces or living remotely within Ontario can be seen by Virtual Care.


Initial investigations

  • V/Q scan
  • Echocardiogram
    (RV focus, RVSP, TAPSE, RV FAC)
  • Bloodwork
    (Group and Screen, CBC, Na, K, Cl, Bicarb, Mg, PO4, Creat, Glu, ALT, AST, ALP, GGT, Total Billi, Amylase, Alb, Protein, INR/PT/aPTT, Fibrinogen, Antithrombin III level, BNP, SC)

Confirmation of CTEPH

  • CTPA
    (0.5-1mm axial slices with 1mm coronal and sagittal views)
  • Right heart catheterization
  • 6-minute walk test (with predicted % walked)
  • PFTs (with DLCO)
  • Venous doppler
  • Possible CPET
  • Possible BREATH study (exercise RHC)
  • Possible pulmonary angiogram (for BPA)

Preparation for Surgery

  • Left heart catheterization
  • Updated CTPA
  • Dopplers
    • Venous lower to r/o DVT, possibly upper to assess patency and line insertion
    • Arterial – femoral and carotid for patency and tor/o stenosis
    • Carotid Arterial for patency stenosis
  • Possible Cardiac MRI
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