The perioperative treatment of open heart surgery cases with preoperative
pulmonary embolism is controversial. A 40-year-old woman, who had undergone mitral valve replacement with a bioprosthetic valve 16 years earlier, showed severe
heart failure, right
pulmonary embolism diagnosed by pulmonary perfusion scan in the subacute stage, and prosthetic valve regurgitation. Preoperative catheterization showed severe
pulmonary hypertension of 122 mmHg, equal to the systemic pressure. Pulmonary angiography showed right peripheral
pulmonary embolism without main pulmonary artery
embolism. Prosthetic valve replacement with a
BICARBON 27 M and tricuspid annuloplasty were performed, with
thrombolytic therapy before and after operation without
thrombectomy, because of
pulmonary hypertension attributed to prosthetic valve regurgitation. Pulmonary perfusion scan and angiography showed improvement of
pulmonary embolism after treatment. Postoperative catheterization showed good results, with right and left pulmonary artery pressure of 43/16(23) and 39/15(24) mmHg, mean pulmonary capillary wedge pressure of 4 mmHg, and cardiac index of 4.96 l/min/m2. It is important to make an early diagnosis of
pulmonary embolism and treat the major cause of
pulmonary hypertension in cases of cardiac valve disease with
pulmonary hypertension.