1. Presented by Jonathan Epstein, M.D. and prepared by ChanJuan Shi, M.D., Ph.D.

A 55 year old man was noted to have a history of chronic thromboembolic pulmonary hypertension and was in heart failure. The patient was scheduled for pulmonary thromboendarterectomy. At surgery he was noted to have complete occlusion of the right pulmonary artery as well as high grade stenosis of the left pulmonary artery. The clot was evacuated although in areas it was very difficult to loosen the "thrombus" from the vessels.

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