| Autor: |
Daily, Pat O., Gilbert Johnston, G., Simmons, Cecile J., Moser, Kenneth M. |
| Zdroj: |
Journal of Thoracic and Cardiovascular Surgery; April 1980, Vol. 79 Issue: 4 p523-531, 9p |
| Abstrakt: |
Failure of pulmonary emboli to undergo fibrinolytic resolution generates a small but significant patient population progressively disabled by hypoxemia, chronic pulmonary hypertension, and eventual right heart failure. Medical management of these patients has not been effective. In the few patients treated surgically, no clear picture has emerged regarding the most effective surgical approach or the late results. Four male patients with chronic pulmonary embolism were managed operatively. Extrapericardial dissection, cardiopulmonary bypass, deep hypothermia, and intermittent circulatory arrest were utilized to perform pulmonary thromboendarterectomy. All patients, ages 30 to 65 years, had had severe dyspnea with minimal exertion for 1 to 20 years. Angiograms showed 50% to 75% of the pulmonary vasculature to be occluded, with frequent involvement of the segmental arteries. Preoperative pulmonary pressures varied from 60/33 to 74/24 mm Hg. Pulmonary vascular resistance values ranged from 450 to 750 dynes-sec-cm-5. All patients survived the operative procedure. The eldest patient died 3 weeks postoperatively following an acute posteroseptal myocardial infarction. The remaining patients had a 20 to 50 mm Hg decrease in pulmonary systolic pressure with a 50% to 75% reduction in pulmonary vascular resistance. Neither static nor dynamic lung volumes were changed appreciably. Follow-up angiograms in all patients confirmed significant increase in pulmonary perfusion. Each patient had improvement in functional capacity; one is completely asymptomatic. The primary advantage of the surgical approach described is the more complete removal of distally located thrombofibrotic material. The late results suggest that this surgical approach should be considered in the management of patients disabled by chronic pulmonary embolism. |
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