Successful Treatment of a Chronic Pulmonary Thromboembolism Associated with Right Atrial Thrombus, Atrial Fibrillation and Tricuspid Insufficiency

(Department of Cardiovascular Surgery, Kimitsu Central Hospital, Kisarazu, Japan, National Hospital Organization Chiba Medical Center*, Chiba, Japan and Labour Health and Welfare Organization Kashima Hospital**, Kamisu, Japan)

Hiroshi Iida Yoshio Sudo Hideo Ukita
Masahisa Masuda* Nobuyuki Nakajima**
We describe an unusual case of a chronic pulmonary thromboembolism with right atrial thrombus. A 56-year-old man suffering from chronic pulmonary thromboembolism for 5 years complained of increasing dyspnea. Computed tomography revealed massive emboli in bilateral pulmonary arteries and a thrombus in the right atrium. Massive tricuspid regurgitation and atrial fibrillation were also recognized. We performed pulmonary thromboendarterectomy using a Jamieson rigid long miniature sucker with a rounded tip and our original flexible sucker under deep hypothermic circulatory arrest. Right atrial thrombectomy, tricuspid annuloplasty and a Maze procedure were also performed during the cooling, recirculating, and warming period. His postoperative cause was uneventful, and he was able to return to an ordinary lifestyle without acquiring oxygen inhalation. Tricuspid annuloplasty and Maze operation during pulmonary thromboendarterectomy contributed to the maintenance of stable homodynamics during and after surgery.
@Jpn. J. Cardiovasc. Surg. 36: 41-44 (2007)