Blood clot removal surgery saving lives

When Jessica Zohs became breathless while walking just a few hundred meters down the street she never anticipated needing life-saving surgery, requiring her heart and blood circulation to be stopped and body cooled to 18 degrees Celsius.

Jessica was 31-years-old when symptoms began in March 2017, and over the next few months her condition deteriorated quickly.

“I was coughing blood daily and my GP said go to The Alfred straight away,” Jessica said.

Jessica was diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH), which is generally caused when blood clots that have developed in other areas of the body, for example the legs, travel and become lodged in arteries that carry blood from the heart to the lungs.

Respiratory Physician at The Alfred, Dr Helen Whitford, said the strain on the heart to pump blood through the blocked arteries is life-threatening.

“The clot gets incorporated into the wall because it’s not being naturally broken down. During surgery, the clot is pulled and dissected out of the artery wall,” said Dr Whitford.

Pulmonary thromboendarterectomy

The surgery is called a pulmonary thromboendarterectomy, or PTE. It’s often the last resort for patients with CTEPH, who are given a life-expectancy of only a few years after being diagnosed. This was a shock to Jessica, who was previously fit and healthy.

Specialists at The Alfred tried to treat Jessica’s clots using medication, but this was ineffective. Besides a lung transplant, PTE surgery was the only solution to save her life.

By this stage, Jessica was ready for a solution, as her whole world was on hold.

“I had to stop work, my heart rate was elevated all of the time and I couldn’t walk more than 50 metres, I struggled to shower and dress myself.”

In November 2017, Jessica was taken into the operating theatre.

“I was thinking let’s get this over and done with, let this be what makes me better. I felt really confident in the team to fix me.”

Complex procedure

The Alfred is one of a small number of sites in Australia equipped to treat patients like Jessica.

During the operation, blood circulation is stopped and the body cooled down from 37 degrees to 18 degrees to minimise the risk of brain damage and other tissue injury. The chest is opened and the surgeon removes the clots from the arteries.

“It requires a quick and accurate surgeon to remove the clots, as they can only work in 20 minute intervals before the body’s circulation needs to be re-established,” said Dr Whitford.

The surgery was a success, though Jessica had to harness all of her strength to recover after such an invasive procedure. In April 2018 Jessica returned to full-time work.

“I was one of the lucky ones, most other people don’t have the opportunity to have this surgery,” said Jessica.

Demand rising

The procedure has been offered at The Alfred since 2014 and demand is rising.

Patients are travelling to The Alfred from South Australia, Tasmania and New Zealand to have the surgery.

“It’s a complex disease that is under-diagnosed. Only a handful of doctors in Australia can perform the complicated surgery,” said Dr Whitford.

Between 10 and 15 PTE surgeries are performed at The Alfred each year.

“Our team needs to assess whether the patient has an acceptable chance of surviving the operation –  a multi-disciplinary team makes these decisions.”

Today Jessica is back to her strong and independent self, with a scar down her chest that she wears as a badge of honour.

“It reminds me how far I have come, and it reminds me to be grateful every day – it’s part of my story,” said Jessica.