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Quick Case

Severe Dyspnea Hampers Healthy Fire Chief

A 48-year-old municipal fire chief from New Mexico began to experience increasingly severe dyspnea. An active man who exercised regularly, he was surprised and alarmed by the condition.

While under the care of a regional medical practice, the patient experienced sudden respiratory decline at home. He was taken to a local hospital emergency department where he was diagnosed with 4 pulmonary emboli, 2 in each lung. He was treated with supplementary oxygen and a blood thinner and released from the hospital following a short stay.

A month after discharge, he experienced another embolism and was referred to a trauma center where the medical team diagnosed chronic thromboembolic pulmonary hypertension (CTEPH). The patient began a course of oral sildenafil. He continued his workouts, but the medical therapy and conditioning did not relieve the worsening dyspnea. The patient sought consultations with a cardiologist, a pulmonologist, and other specialists to discuss options. He was referred to Victor J. Test, MD, a Duke pulmonologist who specializes in surgery to treat pulmonary hypertension (PH).

Question: After work-up and evaluation, what did Duke pulmonologists and thoracic surgeons recommend as the most effective option?

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