Korean J Thorac Cardiovasc Surg.
2010 Jun;43(3):254-259. 10.5090/kjtcs.2010.43.3.254.
The Clinical Outcome of Pulmonary Thromboendarterectomy for the Treatment of Chronic Pulmonary Thromboembolism
- Affiliations
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- 1Department of Thoracic and Cardiovascular Surgery, Dong-A Medical Hospital, College of Medicine, Dong-A University, Korea. jswoo@dau.ac.kr
- 2Department of Thoracic and Cardiovascular Surgery, College of Medicine, Pusan National University Yangsan Hospital, Korea.
- 3Department of Thoracic and Cardiovascular Surgery, College of Medicine, Kangwon National University, Korea.
- KMID: 1455494
- DOI: http://doi.org/10.5090/kjtcs.2010.43.3.254
Abstract
- BACKGROUND
Diagnosing chronic pulmonary embolism at an early stage is difficult because of the patient's non-specific symptoms. This condition is not prevalent in Korea, and in fact, there have been only a few case reports on this in the Korean medical literature. We analyzed the surgical outcome of performing pulmonary thromboendarterectomy in patients with chronic pulmonary embolism. MATERIAL AND METHOD: The study subjects included those patients who underwent surgery for chronic pulmonary embolism from 1996 to 2008. For making the diagnosis, echocardiography, chest CT and a pulmonary perfusion scan were performed on the patients who complained of chronic dyspnea. RESULT: Pulmonary endarterectomy was performed as follows: by incision via a mid-sternal approach (7 patients); by incision via a left posterolateral approach (1 patient); using the deep hypothermic circulatory arrest technique (4 patients); under ventricular fibrillation (3 patients); and under cardioplegic arrest (1 patient). The postoperative systolic pulmonary artery blood pressure significantly decreased from a preoperative value of 78.9+/-14.5 mmHg to 45.6+/-17.6 mmHg postoperatively (p=0.000). The degree of tricuspid regurgitation was less than grade II after surgery. Two patients died early on, including one patient who had persistent pulmonary hypertension without improvement and right heart failure.
CONCLUSION
Patients who have chronic pulmonary embolism are known to have a poor prognosis. However, we think that early surgical treatment along with making the proper diagnosis before the aggravation of right heart failure can help improve the quality of a patient's life.
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