Surgical treatment of acute pulmonary embolism--report of a case
Murakami, T.; Kubota, H.; Aoki, H.; Akasaka, N.; Tateda, K.; Mayumi, T.
Nihon Kyobu Geka Gakkai 36(7): 1200-1205
1988
ISSN/ISBN: 0369-4739 PMID: 3183447 Document Number: 308438
The patient was a 44-year-old so far healthy man with no history of trauma or operation. On his way to the office, he suddenly developed chest pain, cyanosis and dyspnea. On examination blood pressure was 80 mmHg by palpation. Electrocardiogram showed S1O3T3 pattern. Blood gas analysis revealed severe hypoxemia and metabolic acidosis. Diagnosis of massive pulmonary embolism was confirmed by perfusion lung scan and pulmonary arteriography. Despite intensive medical treatment including administration of heparin and urokinase, perfusion defects in the left main pulmonary artery remained almost unchanged. Because the patient still required circulatory and respiratory support. A decision was made to do pulmonary embolectomy. The operation was started 12 hours after the onset of acute symptoms. Under cardiopulmonary bypass, main pulmonary artery was opened and embolus occupying the left pulmonary artery was removed successfully. Two weeks later, venography of the lower extremities was performed and thrombotic occlusion of the left common iliac vein was found. For the prevention of recurrent embolism, external clip was applied to the infrarenal IVC with extraperitoneal apporach. He is resumed to his original work with no signs or symptoms of venous stasis.