Pulmonary thromboembolism (PTE) can develop into chronic pulmonary hypertension. Pulmonary hypertension due to chronic pulmonary thromboembolism is poorly treated by internal medicine and has a poor prognosis. Surgical treatment has achieved good near- and long-term results. From March 1999 to December 2002, we surgically treated 8 cases of pulmonary artery embolism, with 1 case of perioperative death, which is reported as follows. Data and Methods Among the 8 patients with chronic pulmonary artery embolism, there were 5 men and 3 women; their ages ranged from 25 to 68 years old; their body weights ranged from 60 to 80; the duration of the disease ranged from 5 to 36 months. Cardiac function (№mA) class IV in 4 cases, class III in 3 cases, class I/I in 1 case. Deep vein thrombosis of the lower limbs was found in 4 cases, and inferior vena cava filters were inserted in 2 cases before surgery and 1 case after surgery. 8 cases underwent pulmonary perfusion scanning, spiral CT or electron-beam CT, and pulmonary arteriography, which indicated that the lesions were located above the level of the subsegment, and no diffuse lesions were seen at the distal end. Bronchial arteriography was performed in one case, showing a patent distal pulmonary vascular bed. Electrocardiograms all showed right ventricular hypertrophy. Echocardiography in all cases showed severe increase in pulmonary artery pressure, paradoxical septal motion, enlarged and hypertrophied right ventricle, and more than moderate tricuspid regurgitation. Seven cases were operated under extracorporeal circulation. A median incision was used to enter the chest, extracorporeal circulation was routinely established, cooling was performed to 30°C, the superior and inferior vena cava and ascending aorta were blocked, and the aortic root was perfused with 4:1 cold blood stopping fluid for myocardial protection. Deep hypothermia low flow in 5 cases (18 20 ℃), stop circulation (2 cases), each stop circulation is limited to 20 min after resuming perfusion for 10 min, intravenous administration of methylprednisolone 20-25 mg / ks to enhance cerebral protection; sufficiently free the superior vena cava, the pericardial cavity of the right and left pulmonary arteries to the bifurcation of the pericardial cavity to the right atrium incision, to check for interatrial septal defect, according to the results of the angiography and intraoperative palpation to decide the Pulmonary artery incision site, from the pulmonary artery posterior wall of the endothelium and the middle membrane between the establishment of the stripping surface, excision of thrombus, stripping the thickening of the endothelium, until the distal end of the bright red blood reflux, and strive to strip to the level of subsegmental arteries. 6-0 pmlene continuous suture closure of pulmonary arterial incision, if necessary, the application of pericardial patch to expand the pulmonary artery, to prevent the narrowing of pulmonary artery, such as the expansion of the pulmonary artery is obvious, can be ring shrinkage of the lung edema to reduce the. In the process of rewarming, check whether there is oval orifice failure and deal with it. Tricuspid valve insufficiency does not need to be dealt with, but for the combined valve disease or coronary artery disease, it should also be dealt with accordingly. Auxiliary circulation, the application of dopamine to assist cardiac function, prostaglandin E. (PGE). 2 to 10 n kg per minute was pumped in to dilate the pulmonary artery. One case was operated under non-corporeal circulation. A posterior lateral incision was made on the affected side, freeing the lung from adhesion to the wall pleura, freeing the pulmonary hilar, revealing the main trunk and branches of the pulmonary artery, blocking the proximal end of the main trunk of the pulmonary artery, and deciding the site of the pulmonary artery incision based on the results of the enhanced cr, pulmonary arteriography, and the findings of intraoperative palpation, and the rest of the techniques were the same as before. In the early postoperative period, continuous cardiac monitoring, anti-inflammation, restriction of intake and sedation were given as general treatment. Mechanically assisted respiration, applying positive end-expiratory pressure ventilation and inverse ratio breathing. Diuretics and colloid input were applied to reduce pulmonary edema, PGE. and ACEI analogs were given to reduce pulmonary arterial pressure, and heparin anticoagulation was used in the early postoperative period, followed by lifetime anticoagulation with warfarin. Results of 7 cases of extracorporeal circulation under the pulmonary artery thrombus endothelial stripping patients, the average extracorporeal circulation (185 4-30) min. postoperative ventilator-assisted 23 h ~ 18 d. The whole group without brain damage, phrenic nerve paralysis, 5 cases have different degrees of pulmonary reperfusion pulmonary edema, after respiratory treatment 4 cases successfully off the machine; 1 case died 18 d after surgery, autopsy found that the main trunk of the left pulmonary artery again thromboembolism. The partial pressure of arterial oxygen and oxygen saturation were significantly improved at 2 weeks postoperatively without oxygen, and the systolic pressure of pulmonary artery measured by postoperative echocardiography was significantly reduced. At 1-24 months of postoperative follow-up, cardiac function improved to class I in 4 cases and class I/class in 3 cases, and the quality of life was significantly improved. Discussion The clinical features of PTE are diverse and nonspecific, and the rate of missed diagnosis and misdiagnosis is extremely high. Our group was diagnosed according to our “Guidelines for the Diagnosis and Treatment of Pulmonary Thromboembolism (Draft)”. We know that although pulmonary arteriography has a high positive diagnostic rate and is the “gold standard” for the diagnosis of PTE, it also has limitations. We encountered two cases of women who had been diagnosed with chronic thromboembolism of the pulmonary artery, and the postoperative pathology suggested that they were dislodged thrombus of malignant tumors and solitary aortitis of the pulmonary artery, respectively. Strict control of the indications for surgery is one of the keys to surgical success, the most important preoperative assessment of the thrombus must be located in the surgically accessible site J. Because chronic pulmonary embolism pulmonary hypertension can cause irreversible lesions in the small pulmonary vessels, once chronic pulmonary embolism is clearly diagnosed should be performed as soon as possible pulmonary artery thrombus endarterectomy, the basic principles of the incision in the middle of the body, the combination of extracorporeal circulation with deep hypothermia intermittent stopping of the circulation, and the complete endarterectomy J. This case was diagnosed as a chronic pulmonary artery embolism. In our group, 7 cases of PTE were completed under extracorporeal circulation with deep hypothermia and low flow or intermittent stopping circulation, and the surgical process and postoperative recovery were smooth. In our group, 1 case of PTE was completed under non-extracorporeal circulation with smooth intraoperative and postoperative course. The advantages of completing PTE under non-corporeal circulation are that it avoids the influence of extracorporeal circulation, it is easy to peel off the mechanized thrombus and endothelium of segments and subsegments, it is easy to get off the ventilator after the operation, and it is not easy to occur pulmonary edema. However, the disadvantage of PIE is that it is difficult to free the branches of the pulmonary artery due to the side-branch circulation, especially in cases with preoperative inflammation of the chest cavity or lungs. Chronic pulmonary embolism often occurs bilaterally, the application of this procedure should be strictly grasp the indications. The efficacy of non-corporeal surgery, whether the degree of pulmonary vascular bed lesions can be determined by lung biopsy, the timing of surgery and prognosis should be further explored in clinical work. The focus of postoperative management is the prevention and treatment of pulmonary hypertension, pulmonary edema after pulmonary reperfusion and active anticoagulation to prevent reembolization. Aggressive postoperative anticoagulation and prevention of reembolization is the key to the success of pulmonary thromboendarterectomy.