title: A case report of pulmonary thromboendarterectomy for chronic thromboembolism in a patient with protein C deficiency.
abstract: The patient was a 41-year-old female with chronic thromboembolism. She was admitted to an affiliated hospital with exertional dyspnea, leg swelling, and hemoptysis, and she was treated medically with tissue plasminogen activator and warfarin therapy. When transferred to our hospital, she was oxygen-dependent with severe dyspnea. A pulmonary arteriogram showed occlusion and stenosis of the pulmonary arteries. Cardiac catheterization revealed marked pulmonary hypertension. The lung perfusion scintigram showedmultiple defects in the right and left lungs. Preoperative laboratory data showed a markedly decreased protein C antigen level. Magnetic resonance angiography showed that a myoma uteri compressed the pelvic vein and that she had deep vein occlusion of the left leg. After the administration of an epoprostenol infusion and the insertion of an inferior vena cava filter, she underwent an operation. Under deep hypothermia, the bilateral pulmonary artery was opened and an endarterectomy was performed during intermittent circulatory arrest. After surgery, her pulmonary vascular resistance was in the normal range. Her New York Heart Association functional classification changed from class IV to class I. She has been in good condition for 7 years since the surgery.
authors.affiliation: Department of Cardiovascular Surgery, National Defense Medical College, Saitama, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Isoda
authors.forename: Tamizo
authors.initials: T
authors.lastname: Kimura
authors.forename: Kenji
authors.initials: K
authors.lastname: Nishimura
authors.forename: Nozomu
authors.initials: N
authors.lastname: Yamanaka
authors.forename: Shingo
authors.initials: S
authors.lastname: Nakamura
authors.forename: Motomi
authors.initials: M
authors.lastname: Ando
authors.forename: Tadaaki
authors.initials: T
authors.lastname: Maehara
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D002908:Chronic Disease; D004691:Endarterectomy; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D055420:Perfusion Imaging; D020151:Protein C Deficiency / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016306:Vena Cava Filters
chemical_list: D000925:Anticoagulants