oxygen levels in blood (hypoxia). lung transplantation replaces a chronic condition with the ongoing need for treatment. there is a post-surgical median survival of just over five years. pulmonary thromboendarterectomy (pte) is a surgical procedure that is used for chronic thromboembolic pulmonary hypertension. it is the surgical removal of an organized thrombus (clot) along with the lining of the pulmonary artery; it is a very difficult, major procedure that is currently performed in a few select centers. monitoring established clinical practice guidelines dictate the frequency of pulmonary nodule evaluation and surveillance, patients are normally monitored through commonly available tests such as: pulse oximetry arterial blood gas tests chest x-rays serial ecg tests serial echocardiography spirometry or more advanced lung function studies six-minute walk test prognosis cor pulmonale pah is considered a universally fatal illness, although survival time may vary between individuals. the prognosis of pulmonary arterial hypertension (who group i) has an untreated median survival of 2–3 years from time of diagnosis, with the cause of death usually being right ventricular failure (cor pulmonale). the survival time is variable and depends on many factors. a recent outcome study of those patients who had started treatment with bosentan (tracleer) showed that 89% of patients were alive at 2 years. with new therapies, survival rates are increasing. for 2,635 patients enrolled in the registry to evaluate early and long-term pulmonary arterial hypertension disease management (reveal registry) from march 2006 to december 2009, 1-, 3-, 5-, and 7-year survival rates were 85%, 68%, 57%, and 49%, respectively. for patients with idiopathic/familial pah, survival rates were 91%, 74%, 65%, and 59%. levels of mortality are very high in pregnant women with severe pulmonary arterial hypertension (who group i). pregnancy is sometimes described as contraindicated in these women. epidemiology the epidemiology of ipah is about 125–150 deaths per year in the u.s., and worldwide the incidence is similar at 4 cases per million. however, in parts of europe (france), indications are 6 cases per million of ipah. females have a higher incidence rate than males (2–9:1). other forms of ph are far more common. in systemic scleroderma, the incidence has been estimated to be 8 to 12% of all patients; in rheumatoid arthritis it is rare. however, in systemic lupus erythematosus it is 4 to 14%, and in sickle cell disease, it ranges from 20 to 40%. up to 4% of people who develop a pulmonary embolism go on to develop chronic thromboembolic disease including pulmonary hypertension. a small percentage of patients with copd develop pulmonary hypertension with no other disease to explain the high pressure. on the other hand, obesity-hypoventilation syndrome is very commonly associated with right heart failure due to pulmonary hypertension. research for people that inherited the disease, gene therapy is being studied. culture and society notable cases elaine kaufman, american restaurateur ina balin, american broadway and tv actress chloe temtchine, american singer-songwriter natalie cole, american singer