Emergency combined open pulmonary embolectomy and aortocoronary bypass surgery
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Emergency Combined Open Pulmonary Embolectomy and Aortocoronary Bypass Surgery Case Report P.Misthos, J. Kokotsakis, D. Bulafentis, G. Lazopoulos, K. Neofotistos, A. Lioulias
Abstract This is a case of an emergency combined pulmonary embolectomy and CABG. A 67-year-old male was admitted to our department for a scheduled aortoconary bypass due to 3-vessel disease. The patient had a history of an inferior acute myocardial infarction 1 year earlier. During the night of admission, the patient became severely dyspnoic and diaphoretic with a high heart rate and low blood pressure. After initial rescuscitation, he was taken to the operating room for an emergency aortoconary bypass as a life saving intervention. A large thrombus in the pulmonary artery trunk was also detected. Pulmonary artery arteriotomy was performed and thrombectomy was accomplished with Fogarty catheter. The operation was completed with 3-vessel coronary grafting. The postoperative course was uneventful. Rescue embolectomy for compromised patients remains an option for treatment of massive PE.
Keywords
Pulmonary embolism, Aortoconary bypass surgery, Embolectomy
Introduction Pulmonary embolism (PE) remains a life threatening complication [1]. The majority of PE cases are effectively managed with conservative measures, i.e. heparine. In a few instances, thrombolysis may be used. However, in cases where a significant part of pulmonary circulation has been obstructed, and the hemodynamics is severely deranged, PE may be managed surgically. Although several cases of pulmonary artery embolism occurring immediately after aortoconary bypass surgery (CABG) have been documented [2, 3], this is the first case of combined pulmonary embolectomy and CABG to be reported.
Sismanogleio General Hospital, Thoracic Surgery Department, Athens, Greece Received 24/09/2009 Accepted 25/11/2009
Case report A 67-year-old patient was admitted to our department for a scheduled aortoconary bypass due to 3-vessel disease. The patient had a history of an inferior acute myocardial infarction 1 year earlier and suffered from type II diabetes mellitus. He had quit smoking one month before admission. The patient presented with unstable angina and dyspnea (NYHA III) and was managed with intravenous infusion of heparin and nitrate. During the night of admission, the patient became severely dyspnoic and diaphoretic with a high heart rate and low blood pressure. After initial rescuscitation, he was taken to the operating room for an emergency aortoconary bypass as a life saving intervention. Swan Ganz catheterization disclosed virtual equalization of pulmonary and systematic blood pressure. After sternotomy and pericardial incision, the right ventricle was found to be severely distended and hypokinetic. Extracorporeal cardiopulmonary bypass was instituted as fast as possible in order to avoid cardiac arrest. Intraoperative transesophageal echocardiography showed severe tricuspid regurgitation associated with an intact mitral valve and raised serious suspicion of a large thrombus in the
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