Acute Pulmonary Thromboembolism Associated with Chronic Thromboembolic Pulmonary Hypertension Treated by Emergency Embolectomy and Delayed Pulmonary Endarterectomy

Kazuho Niimi＊	Koyu Tanaka＊	Naoki Asano＊
Kazunori Ota＊	Masahito Saito＊	Shigeyoshi Gon＊
Keiichi Ishida＊＊	Hiroshi Takano＊

（Department of Cardiovascular Surgery, Dokkyo Medical University Saitama Medical Center＊, Koshigaya, Japan, and Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine＊＊, Chiba, Japan）

A 46-year-old man who had been hospitalized for treatment of pneumonia was referred to our hospital with a diagnosis of acute pulmonary thromboembolism. Multi-detector row computed tomography revealed massive thrombi in the bilateral main pulmonary arteries. Transthoracic echocardiography showed dilated right heart chambers and a large floating thrombus in the right atrium. Emergency thromboembolectomy was performed. Although fresh thrombi were removed from the right atrium and left main pulmonary artery, organized old thrombi were present in the bilateral pulmonary arteries, leading to a diagnosis of chronic thromboembolic pulmonary hypertension. Because no instruments were available for pulmonary endarterectomy, the surgery was terminated with percutaneous cardiopulmonary support. Five days postoperatively, pulmonary endarterectomy was performed under deep hypothermic circulatory arrest. The postoperative course was uneventful, and the patient returned to his preoperative lifestyle without the need for oxygen support.
　　

Jpn. J. Cardiovasc. Surg. 47:100-104（2018）

Keywords：chronic thromboembolic pulmonary hypertension;acute pulmonary thromboembolism;pulmonary endarterectomy