Operation for chronic pulmonary thromboembolism accompanied by thrombophilia in 8 patients.

Abstract

BACKGROUND:

Medical therapy for chronic pulmonary thromboembolism is limited, and surgical treatment has become more frequent recently. We have performed pulmonary thromboendarterectomy on 8 patients with chronic pulmonary thromboembolism accompanied by thrombophilia.

METHODS:

The patients were 6 men and 2 women aged 21 to 56 years (mean, 35 years). Five patients had antiphospholipid syndrome, 2 had protein C deficiency, and 1 had congenital antithrombin III deficiency. The preoperative condition was New York Heart Association functional class III in 5 and class IV in 3. Hypoxemia, marked pulmonary hypertension (mean pulmonary artery pressure, 47+/-6.7 mm Hg), and low cardiac output were observed in all patients. After a median sternotomy, deep hypothermia was induced using a cardiopulmonary bypass, and pulmonary thromboendarterectomy in the bilateral pulmonary arteries was performed under intermittent circulatory arrest.

RESULTS:

There were no operative deaths. Long-term respiratory management was needed postoperatively by 3 patients. In the remaining 5 patients, no reperfusion injury was observed. The arterial blood oxygen concentration improved, and the mean pulmonary pressure decreased to 16+/-5.5 mm Hg. The cardiac output also increased, and New York Heart Association functional class improved to I in 4 and II in 4 patients.

CONCLUSION:

Pulmonary thromboendarterectomy under deep hypothermic intermittent circulatory arrest was effective for chronic pulmonary thromboembolism accompanied by thrombophilia for which medical treatment is of limited value.

• Authors: M Ando, S Takamoto, Y Okita, R Matsukawa, N Nakanishi, S Kyotani, T Satoh
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 66 Issue 6 Pg. 1919-24 (Dec 1998) ISSN: 0003-4975 [Print] Netherlands
• PMID: 9930469 (Publication Type: Journal Article)

Topics

• Adult
• Antiphospholipid Syndrome (complications)
• Antithrombin III Deficiency (complications)
• Cardiopulmonary Bypass
• Chronic Disease
• Endarterectomy
• Female
• Humans
• Hyperthermia, Induced
• Male
• Protein C Deficiency (complications)
• Pulmonary Artery (surgery)
• Pulmonary Embolism (complications, surgery)
• Thrombophilia (complications)