Perspectives of embolectomy when treating acute massive pulmonary artery emboly

The study focuses on surgical treatment of 31 patients with massive pulmonary artery thromboemboly (PATE) over a period from 1997 to 2008. The patients' age varied from 21 to 50 years. 26 patients had venous thrombosis of deep veins of lower extremities, 1 patient - right ventricle thrombosis, 2 - subcutaneous fractures of lower leg bones with ileofemoral throm-bosis symptoms, 2 patients - inferior vena cava thrombosis. The disease lasted over a period from 18 hours to 18 days. Pulmonary angiography played a crucial role in topic diagnostics of PATE. Embolectomy in 30 patients was performed under hypothermic or normo-thermic conditions with the use of cardioplegia. In the immediate postoperative period two (6.5 %) patients having the symptoms of chronic PATE died. One patient with concomitant destructive pneumonia died on the 12th day after surgery on lung abscess and bronchial fistula. The second patient died when right ventricle insufficiency dramatically aggravated. In the postoperative period the pressure in the right ventricle dropped to 28 - 35 mm Hg and the ejection fraction increased up to 58 - 70 % in 26 patients (86.7 %). Recurrence of PATE was observed in 1 patient who was re-operated on the 19th day of the follow-up. In the long-term period 25 patients (80 %) were studied. One patient demonstrated some symptoms of high pulmonary hypertension. In another patient recurrent PATE was noted 6 months after operation, which required thrombolysis. The authors suggest that in the case of massive PATE accompanied by considerable disturbances of hemodynamics, embolectomy is recommended as early as several days from the onset of disease.