| Two Cases of Acute Pulmonary
Embolisms with Floating Thrombi in the Right Heart |
(Department of Cardiovascular Surgery, National
Chiba Hospital, Chiba, Japan)
| Toshiaki Ohto |
Masahisa Masuda |
Yoshihisa Tsukagoshi |
|
Emergency operation was performed
for 2 cases of acute pulmonary embolism which showed floating
thrombi in the right atrium and right ventricle. Case 1 was a
48-year-old man without any contributory past history. Case 2
was a 65-year-old woman with a history of old myocardial infarction
and chronic left heart failure with only 19% of the left ventricular
ejection fraction. Although their preoperative hemodynamics and
respiratory conditions were stable, ultrasound examination revealed
floating thrombi in the right heart. Sudden death could have
occurred if the occlusions had migrated to the pulmonary artery.
Thus, emergency operation was selected instead of thrombolysis.
During operation, the blood pressure suddenly decreased before
the establishment of the cardiopulmonary bypass in both cases.
This may have been the result of sudden additional pulmonary
embolism, because no floating thrombi were noted in the right
atrium or right ventricle at operation. After operation, case
1 recovered quickly although case 2 was discharged only after
6 months. It is highly possible that the presence of right heart
thrombi change the hemodynamics rapidly. Therefore, emergency
operation is necessary even when the hemodynamics and respiratory
condition are stable. Thrombectomy is recommended even to patients
such as case 2 in a serious condition, because this surgical
procedure under cardiopulmonary bypass has been proven to be
very safe.
Jpn. J. Cardiovasc. Surg. 33: 266-269 (2004) |
|
