Minimally Invasive Pulmonary Thromboendarterectomy by a J-Shaped Upper Hemisternotomy

Chronic thromboembolic pulmonary hypertension is a rare but serious condition caused by pulmonary artery thrombi. Pulmonary thromboendarterectomy through median sternotomy is the "gold standard," but minimally invasive approaches are emerging. We describe a 22-year-old female athlete with May-Thurner syndrome and factor V Leiden and prothrombin mutations in whom pulmonary embolism developed. After failed thrombectomy, she underwent pulmonary thromboendarterectomy by J-shaped upper hemisternotomy. Circulatory arrest time was 24 minutes; cardiopulmonary bypass time, 131 minutes; and cross-clamp time, 51 minutes. This technique is feasible and safe, achieving comparable outcomes to full sternotomy while improving cosmesis, making it an appealing option for selected patients.