Acute masive pulmonary embolism – indication for surgical thromboembolectomy

Czech version

Authors: A. Mokráček ¹; M. Vambera ²; M. Šulda ¹; M. Šetina ¹; F. Toušek ²
Authors‘ workplace: Kardiochirurgické oddělení Nemocnice České Budějovice, přednosta prim. MUDr. Marek Šetina, CSc. ¹; Kardiologické oddělení Nemocnice České Budějovice, přednosta prim. MUDr. František Toušek ²
Published in: Vnitř Lék 2005; 51(6): 734-739
Category: Case Reports

Overview

The authors report the case of 63-year-old man with hypertension admitted to heart center with extreme respiratory distress, cyanosis, somnolence and manifestations of acute cor pulmonale. His admission was preceded by one-month history of worsening of dyspnea peaking on day before admission by a presyncopic state. Ultrasound demonstrated a freely rotating thrombus in the right atrium, massive pulmonary embolism with a big thrombus in the right pulmonary artery, foramen ovale patens and severe right ventricular dysfunction. Within 90 minutes of admission, the patient in a critical circulatory state, was connected to extracorporeal circulation. A surgeon removed a long thrombus from the righ atrium, performed endarterectomy and thrombectomy of both pulmonary artery branches and closed foramen ovale patens. Following twelve days hospitalisation, the patient, in the stable condition and receiving anticoagulation with warfarin, was transferred to an internal department to fully recover. In the discussion section, the authors review current indication and the philosophy of surgical pulmonary thrombectomy.

Key words:
pulmonary embolism – thrombembolectomy

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