1Cardiac Surgeon, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2Anesthesiologist, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
3Resident of Anesthesiology, Department of Anesthesiology, Mashhad University of Medical Sciences, Mashhad, Iran
4Master in Medical Education, Mashhad, Iran
Introduction: Pulmonary embolism is one of the leading causes of mortality in patients.The mortality rate of this disease can be significantly reduced with appropriate treatment. Surgical intervention can be highly effective for the treatment of acute massive pulmonary embolism. This article presents a report on the experience of acute pulmonary embolectomy. Materials and Methods: Demographic data, rate of mortality, as well as surgical and post-operative complications were recorded and analyzed. Results: In general, 12 patients with mean age of 60±13.39 year were included in the study. None of the patients had significant arrhythmia during the surgery, but 25% suffered from post-operative arrhythmia. Moreover, electrical cardioversion was administered to 8% of the patients, 8% received pharmaceutical interventions, and the rest of the patients sustaining arrhythmia (9%) survived with specific metabolic correction. The diagnosis of acute pulmonary embolism was correct in 100% of the patients, with 33.3% of the cases suffering from this disease due to recent surgeries. In 41.6% of the patients, blood clots were observed in the pulmonary artery, right atrium, and right ventricle. The three-month follow-up of the patients showed that 83.3% of the cases were alive. There were two cases of mortality, one of which occurred at the end of surgical procedure and the other one happened in the intensive care unit. The results of independent t-test did not indicate any significant relation between mortality and ejection fraction of the patients (P=0.189). Moreover, there were not any significant differences between the patients’ pre- and post-operative laboratory tests (P˃0.05). Nonetheless, hemoglobin and hematocrit levels were significantly different pre- and post-operation (P=0.0001). Conclusion: Our data suggest that acute pulmonary embolism can be treated successfully with favorable outcome and a mortality rate of approximately 16.6%, if evaluation and diagnosis are done as soon as possible in patients who require surgical intervention.
1. Ocak I, Fuhrman C. CT angiography findings of the left atrium and right ventricle in patients with massive pulmonary embolism. AJR Am J Roentgenol. 2008; 191:1072-6.
2. Reid JH, Murchison JT. Acute right ventricular dilatation: a new helical CT sign of massive Pulmonary embolism. Clin Radiol. 1998; 53:694-8.
3. Heit JA, Silverstein MD, Mohr DN, Petterson TM, Lohse CM, O’Fallon WM, et al. The epidemiology of venous thromboembolism in the community. Thromb Haemost. 2001; 86:452-63.
4. Heit JA. The epidemiology of venous thromboembolism in the community: implications for prevention and management. J Thromb Thrombolysis. 2006; 21:23-9.
5. Horlander KT, Mannino DM, Leeper KV. Pulmonary embolism mortality in the United States, 1979-1998: an analysis using multiple-cause mortality data. Arch Intern Med. 2003; 163:1711-7.
6. Kucher N, Goldhaber SZ. Management of massive pulmonary embolism. Circulation. 2005; 112:e28-32.
7. Wu AS, Pezzullo JA, Cronan JJ, Hou DD, Mayo-Smith WW. CT pulmonary angiography: quantification of pulmonary embolus as a predictor of patient outcome--initial experience. Radiology. 2004; 230:831-5.
8. Santos Martinez LE, Uriona Villarroel JE, Exaire Rodriguez JE, Mendoza D, Martínez Guerra M, Pulido T, et al. Massive pulmonary embolism, thrombus in transit, and right ventricular dysfunction. Arch Cardiol Mex. 2007; 77:44-53.
9. Van der Meer RW, Pattynama PM, Van Strijen MJ, Van den Berg-Huijsmans AA, Hartmann IJ, Putter H, et al. Right Ventricular dysfunction and pulmonary obstruction index at helical CT: prediction of clinical outcome during 3-month follow-up in patients with acute pulmonary embolism. Radiology. 2005; 235:798-803.
10. Ghasemieh J, Rezaei Talab F. Clinical assessment, diagnosis and mortality in acute thromboembolism. Med J Mashhad Univ Med Sci. 2008; 51:115-20.
11. Samoukovic G, Malas T, deVarennes B. The role of pulmonary embolectomy in the treatment of acute pulmonary embolism: a literature review from 1968 to 2008. Interact Cardiovasc Thorac Surg. 2010; 11:265-70.
12. Stein PD, Alnas M, Beemath A, Patel NR. Outcome of pulmonary embolectomy. Am J Cardiol. 2007; 99:421–3.
13. Anderson FA Jr, Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003; 107:9-16.
14. Osborne ZJ, Rossi P, Aucar J, Dharamsy S, Cook S, Wheatly B. Surgical pulmonary embolectomy in a community hospital. Am J Surg. 2014; 207:337-1.
15. Yavuz S, Toktas F, Goncu F, Eris C, Gucu A, Ay D, et al. Surgical embolectomy for acute massive pulmonary embolism. Int J Clin Exp Med. 2014; 7:5362–75.