Abstract
The operative removal of thrombo-emboli from the pulmonary arteries in acute pulmonary embolism is an accepted method of treatment. The removal of thrombi that have been present for many months has been attempted less often. This case report covers the operative treatment and the pre- and post-operative physiological studies in a patient with long-standing thrombo-embolic pulmonary hypertension, in whom a large thrombus was removed under cardiopulmonary bypass from the left pulmonary artery. Dramatic clinical improvement resulted. A plea is made for a more radical approach to thrombo-embolic pulmonary hypertension when a local obstruction can be demonstrated.
Full text
PDFImages in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- ALLISON P. R., DUNNILL M. S., MARSHALL R. Pulmonary embolism. Thorax. 1960 Dec;15:273–283. doi: 10.1136/thx.15.4.273. [DOI] [PMC free article] [PubMed] [Google Scholar]
- BALL K. P., GOODWIN J. F., HARRISON C. V. Massive thrombotic occlusion of the large pulmonary arteries. Circulation. 1956 Nov;14(5):766–783. doi: 10.1161/01.cir.14.5.766. [DOI] [PubMed] [Google Scholar]
- BARRITT D. W., JORDAN S. C. Anticoagulant drugs in the treatment of pulmonary embolism. A controlled trial. Lancet. 1960 Jun 18;1(7138):1309–1312. doi: 10.1016/s0140-6736(60)92299-6. [DOI] [PubMed] [Google Scholar]
- CASE RECORDS of the Massachusetts General Hospital; case 43311. N Engl J Med. 1957 Aug 1;257(5):235–241. doi: 10.1056/NEJM195708012570511. [DOI] [PubMed] [Google Scholar]
- COOLEY D. A., BEALL A. C., Jr Surgical treatment of acute massive pulmonary embolism using temporary cardiopulmonary bypass. Dis Chest. 1962 Jan;41:102–104. doi: 10.1378/chest.41.1.102. [DOI] [PubMed] [Google Scholar]
- FRATER R. W., BECK W., SCHRIRE V. THE SYNDROME OF PULMONARY ARTERY ANEURYSMS, PULMONARY ARTERY THROMBI, AND PERIPHERAL VENOUS THROMBI. J Thorac Cardiovasc Surg. 1965 Feb;49:330–338. [PubMed] [Google Scholar]
- GOODWIN J. F., HARRISON C. V., WILCKEN D. E. Obliterative pulmonary hypertension and thrombo-embolism. Br Med J. 1963 Mar 16;1(5332):701–contd. doi: 10.1136/bmj.1.5332.701. [DOI] [PMC free article] [PubMed] [Google Scholar]
- GORHAM L. W. A study of pulmonary embolism. III. The mechanism of pain; based on a clinicopathological investigation of 100 cases of minor and 100 cases of massive embolism of the pulmonary artery. Arch Intern Med. 1961 Sep;108:418–426. doi: 10.1001/archinte.1961.03620090090011. [DOI] [PubMed] [Google Scholar]
- HAMPSON J., MILNE A. C., SMALL W. P. The surgical treatment of pulmonary embolism. Lancet. 1961 Aug 19;2(7199):402–404. doi: 10.1016/s0140-6736(61)92484-9. [DOI] [PubMed] [Google Scholar]
- HEILMAN R. S., TABAKIN B. S., HANSON J. S., NAEYE R. L. Alterations of circulatory and ventilatory dynamics in pulmonary vascular obstruction secondary to recurrent pulmonary emboli. Case report, with studies of pulmonary physiology. Am J Med. 1962 Feb;32:298–303. doi: 10.1016/0002-9343(62)90296-6. [DOI] [PubMed] [Google Scholar]
- HOUK V. N., HUFNAGEL C. A., MCCLENATHAN J. E., MOSER K. M. CHRONIC THROMBOTIC OBSTRUCTION OF MAJOR PULMONARY ARTERIES. REPORT OF A CASE SUCCESSFULLY TREATED BY THROMBENDARTERECTOMY, AND A REVIEW OF THE LITERATURE. Am J Med. 1963 Aug;35:269–282. doi: 10.1016/0002-9343(63)90218-3. [DOI] [PubMed] [Google Scholar]
- HUME M., GLENN W. W., GRILLO T. Behavior in the circulation of the radioactive pulmonary embolus and its application to the study of fibrinolytic enzymes. Ann Surg. 1960 Apr;151:507–516. doi: 10.1097/00000658-196004000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- HURWITT E. S., SCHEIN C. J., RIFKIN H., LEBENDIGER A. A surgical approach to the problem of chronic pulmonary artery obstruction due to thrombosis or stenosis. Ann Surg. 1958 Feb;147(2):157–165. doi: 10.1097/00000658-195802000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
- JONES N. L., GOODWIN J. F. RESPIRATORY FUNCTION IN PULMONARY THROMBOEMBOLIC DISORDERS. Br Med J. 1965 Apr 24;1(5442):1089–1093. doi: 10.1136/bmj.1.5442.1089. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Makey A. R., Bliss B. P. Pulmonary embolectomy. A review of five cases with three survivals. Lancet. 1966 Nov 26;2(7474):1155–1158. doi: 10.1016/s0140-6736(66)90474-0. [DOI] [PubMed] [Google Scholar]
- Milligan R. S., Olsen P. A., Toole G. J., Wood N. E. Surgical treatment of massive pulmonary embolism. Calif Med. 1966 Mar;104(3):204–208. [PMC free article] [PubMed] [Google Scholar]
- Moser K. M., Houk V. N., Jones R. C., Hufnagel C. C. Chronic, massive thrombotic obstruction of the pulmonary arteries. Analysis of four operated cases. Circulation. 1965 Sep;32(3):377–385. doi: 10.1161/01.cir.32.3.377. [DOI] [PubMed] [Google Scholar]
- PHEAR D. Pulmonary embolism. A study of late prognosis. Lancet. 1960 Oct 15;2(7155):832–835. doi: 10.1016/s0140-6736(60)91903-6. [DOI] [PubMed] [Google Scholar]
- SABISTON D. C., Jr, WAGNER H. N., Jr THE PATHOPHYSIOLOGY OF PULMONARY EMBOLISM: RELATIONSHIPS TO ACCURATE DIAGNOSIS AND CHOICE OF THERAPY. J Thorac Cardiovasc Surg. 1965 Sep;50:339–356. [PubMed] [Google Scholar]
- SAUTTER R. D., LAWTON B. R., MAGNIN G. E., EMANUEL D. A. PULMONARY EMBOLECTOMY. REPORT OF A CASE WITH PREOPERATIVE AND POSTOPERATIVE ANGIOGRAMS. N Engl J Med. 1963 Nov 7;269:997–999. doi: 10.1056/NEJM196311072691902. [DOI] [PubMed] [Google Scholar]
- SHARP E. H. Pulmonary embolectomy: successful removal of a massive pulmonary embolus with the support of cardiopulmonary bypass. Case report. Ann Surg. 1962 Jul;156:1–4. doi: 10.1097/00000658-196207000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- SNYDER W. A., KENT D. C., BAISCH B. F. Successful endarterectomy of chronically occluded pulmonary artery. Clinical report and physiologic studies. J Thorac Cardiovasc Surg. 1963 Apr;45:482–489. [PubMed] [Google Scholar]
- STEENBURG R. W., WARREN R., WILSON R. E., RUDOLF L. E. A new look at pulmonary embolectomy. Surg Gynecol Obstet. 1958 Aug;107(2):214–220. [PubMed] [Google Scholar]
- Shapiro S., Clark T. J., Goodwin J. F. Delayed closure of the pulmonary valve in obliterative pulmonary hypertension. Lancet. 1965 Dec 11;2(7424):1207–1211. doi: 10.1016/s0140-6736(65)90634-3. [DOI] [PubMed] [Google Scholar]
- WILCKEN D. E., MACKENZIE K. M., GOODWIN J. F. Anticoagulant treatment of obliterative pulmonary hypertension. Lancet. 1960 Oct 8;2(7154):781–783. doi: 10.1016/s0140-6736(60)91854-7. [DOI] [PubMed] [Google Scholar]
- WINTERSCHEID L. C., DILLARD D. H., BLACKMON J. R., FIGLEY M. N., CRAWFORD E. W., MERENDINO K. A. THE SPECTRUM OF PATIENTS WITH PULMONARY EMBOLISM. Am J Surg. 1965 Aug;110:247–256. doi: 10.1016/0002-9610(65)90019-x. [DOI] [PubMed] [Google Scholar]
- WOOD P. Pulmonary hypertension with special reference to the vasoconstrictive factor. Br Heart J. 1958 Oct;20(4):557–570. doi: 10.1136/hrt.20.4.557. [DOI] [PMC free article] [PubMed] [Google Scholar]