The management of CTEPH patients requires a skilled multidisciplinary team consisting of physicians to participate in preoperative assessment and postoperative care, surgeons and anesthesiologists with expertise in intraoperative techniques of endarterectomy and extracorporeal cardiopulmonary support, and a nursing staff that has been trained in the care of these patients during a sometimes challenging postoperative course. Persistent pulmonary hypertension from residual, organized thrombi or inoperable small vessel arteriopathy4and reperfusion pulmonary edema5 are the most difficult and life-threatening postoperative events. At centers with experience performing PTE, a mortality rate of ≤ 5% has been quoted,1–2 which is a remarkable achievement when one considers the severity of the cardiopulmonary disease and the hemodynamic fragility of these patients. The greatest risk is in those patients with the highest levels of pulmonary vascular resistance, particularly when right ventricular function is severely impaired.6 In this issue of CHEST (see page 338), Nagaya and colleagues report their experience using continuous IV epoprostenol (prostacyclin, Flolan; GW USA Inc; Research Triangle, NC) as a “medical bridge” to stabilize such patients prior to their undergoing PTE. Their study was not a randomized trial, rather, the patients were selected for epoprostenol therapy based on the severity of their hemodynamic condition and their increased risk of death with PTE. The epoprostenol-treated patients manifested significant hemodynamic improvement with a course of therapy that averaged less than 2 months’ duration, and all except one patient survived the surgery and had an excellent hemodynamic result.