Clinical and pathophysiologic syndromes in which endogenous or exogenous emboli occlude the pulmonary arteries causing obstruction of the pulmonary circulation. According to the progress of the disease can be divided into acute pulmonary embolism and chronic pulmonary embolism. Acute pulmonary artery embolism clinical characteristics: acute onset, severe symptoms, shorter course of the disease, can quickly appear shock or even death. The main lesion is fresh thrombus externally dislodged, which is relatively brittle. Has not yet appeared in the pulmonary artery endothelial hyperplasia, thickening and fibrosis and other pathological changes Acute pulmonary artery embolism surgical thrombus surgery indications: 1, the main trunk of the pulmonary artery or the main branches of the sub-total occlusion, blockage range > 50%, and does not combine with the fixed pulmonary arterial hypertension. 2.Pulmonary embolism is complicated by obvious circulatory and respiratory dysfunction, cardiac arrest, shock, lower blood pressure, increased central venous pressure, renal failure. 3, internal medicine treatment is not improved or there are contraindications to thrombolysis should not be internal medicine treatment. Surgical thrombolysis surgery characteristics and effects Cutting open the pulmonary artery to remove thrombus directly, without stripping the endothelium, generally do not need deep hypothermia to stop the circulation, can be combined with Forgarty balloon thrombus. Acute pulmonary embolism due to poor systemic condition, the operation mortality rate is high, domestic and foreign data reported that it can be as high as 8%~40%. However, the 5-year survival rate after surgery is 90.8 earth 5.2. Chronic thromboembolic pulmonary hypertension (CTEPH). Acute pulmonary embolism about 3.8% develop into CTEPH, each year the United States of America’s new cases to reach 12-15 million, only about 200 cases of CTEPH get surgery CTEPH treatment 1, drug treatment: only symptomatic treatment, and ultimately the emergence of pulmonary arterial hypertension, right heart failure, and a high mortality rate. 2.Pulmonary endarterectomy (PEA) is the best choice for the treatment of chronic pulmonary embolism as it cuts through the pulmonary artery to remove the thrombus directly, often needing to peel off the endothelium. 3, lung transplantation: advanced CTEPH patients can not be the only option for PEA. Indications for PEA 1, New York cardiac function classification: class II-IV; 2, the thrombus is mainly located in the surgically accessible part of the pulmonary artery; 3, the average pulmonary vascular resistance (PVR) >300 (800~1000) dyn.s.cm-5; 4, resting or exercise state of hemodynamic and respiratory abnormalities of the symptomatic patients; 5, not accompanied by life-threatening other serious diseases, such as chronic obstructive pulmonary disease, left heart disease, heart disease, heart disease, heart disease, heart disease, heart disease, heart disease, heart disease, heart disease, heart disease, heart disease and other diseases. Surgical steps and techniques for PEA, e.g., chronic obstructive pulmonary disease, left heart failure Double-lumen endotracheal intubation to facilitate suctioning of endobronchial secretions in the event of pulmonary edema on one side of the lung. A median sternal incision is made, extracorporeal circulation is established, and the thickened intima is peeled off from between the intima and the intima layer of the pulmonary artery and the mechanized thrombus on its surface. The key to the procedure is to find the correct level and successively peel off the thickened pulmonary artery intima until bright red blood returns distally.