title: Acute massive pulmonary embolism: role of the cardiac surgeon.
abstract: We present the case of a 72-year-old woman who had an acute massive pulmonary embolism after abdominal surgery. The patient had undergone a right hemicolectomy and pancreaticoduodenectomy for locally invasive colonic adenocarcinoma. Six hours postoperatively, she required emergent intubation when she suddenly became cyanotic, severely hypotensive, and tachypneic, with an oxygen saturation of 50%. An acute massive pulmonary embolism was suspected, and an emergency transesophageal echocardiogram confirmed the diagnosis. On the basis of the patient's clinical condition and the echocardiographic findings, we performed an emergent pulmonary embolectomy, with the patient on cardiopulmonary bypass. We evacuated multiple large clots from both pulmonary arteries. The patient recovered and was discharged from the hospital 61 days postoperatively. Herein, we review the current literature on open surgical pulmonary embolectomy. This case supports the use of open pulmonary embolectomy for the treatment of hemodynamically unstable patients on the basis of clinical diagnosis. We discuss the role of emergent transesophageal echocardiography in the diagnosis and management of massive pulmonary embolism.
authors.affiliation: Department of Surgery, State University of New York-Downstate Medical Center, Brooklyn, New York 11203-2098, USA.
authors.forename: Allreza
authors.initials: A
authors.lastname: Sadeghi
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Brevetti
authors.forename: Sanghyun
authors.initials: S
authors.lastname: Kim
authors.forename: Joshua H
authors.initials: JH
authors.lastname: Burack
authors.forename: Mark H
authors.initials: MH
authors.lastname: Genovese
authors.forename: Dale A
authors.initials: DA
authors.lastname: Distant
authors.forename: Ramesh
authors.initials: R
authors.lastname: Kodavatiganti
authors.forename: Robert C
authors.initials: RC
authors.lastname: Lowery
mesh_terms: D000208:Acute Disease; D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D003082:Colectomy / Q000009:adverse effects; D003110:Colonic Neoplasms / Q000601:surgery; D017548:Echocardiography, Transesophageal; D017128:Embolectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000601:surgery; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*