Surgical Salvage of Acute Pulmonary Thromboembolism Supported by a Percutaneous Cardiopulmonary Bypass System

(Department of Cardiovascular Surgery, Nagoya Second Red Cross Hospital, Nagoya, Japan)

Yoshimori Araki Kazuyoshi Tajima Jiniti Iwase
Tomonobu Abe Wataru Kato Keisuke Tanaka
Akinori Io Yoshito Suenaga
We report a 66-year-old woman with circulatory collapse due to acute pulmonary thromboembolism, in whom a left nephrectomy for a renal tumor was scheduled. Following preoperative renal angiography. The patient suffered sudden shock resulting from pulmonary thromboembolism (PTE) following release of compression of the puncture site. The patient was transported to the ICU, and percutaneous cardiopulmonary support (PCPS) was instituted immediately for resuscitation. Hemodynamics were stabilized by PCPS and percutaneous thrombectomy was attempted. However, perforation by a catheter inverted to the extracardiac space occurred, which neccesitated emergency surgical hemostasis. PCPS was converted to cardiopulmonary bypass (CPB). The injured right ventricle and right atrial walls were repaired, and pulmonary thrombectomy was performed via the pulmonary trunk. CPB was easily terminated and her postoperative course was uneventful with anticoagulant therapy. Left nephrectomy was performed two months later. PTE recurred due to the interruption of anticoagulation for surgical treatment of a renal tumor. Percutaneous pulmonary thrombectomy and thrombolysis therapy were effective and a Greenfield filter was inserted into the inferior vena cava to prevent recurrence.
@Jpn. J. Cardiovasc. Surg. 29: 122-125 (2000)