Thrombectomy for pulmonary embolism under general anesthesia and cardiopulmonary bypass: a case report

Abstract

Abstract Background Pulmonary embolism (PE) is a kind of pulmonary circulatory failure caused by endogenous or exogenous emboli blocking the pulmonary artery or its branches. Giant embolic pulmonary embolism can cause acute right heart failure, acute respiratory failure, and even sudden death. For patients with a large number of PE and hemodynamic instability, thrombolytic therapy, inferior vena cava filter placement, or thrombectomy are usually considered. This paper reports a case of pulmonary artery thrombectomy under cardiopulmonary bypass. The patient had pulmonary thrombosis caused by deep venous thrombosis of the lower extremities and underwent pulmonary artery thrombectomy under general anesthesia and cardiopulmonary bypass. Case presentation: A 59-year-old man was admitted to the hospital due to chest tightness and shortness of breath for half a month, which worsened for 3 days.Pulmonary hypertension (moderate). Color Doppler ultrasound of both lower extremities demonstrated deep venous thrombosis in the left lower limb (the percentage diameter stenosis was about 100%), and no thrombosis was found in the right lower limb. Physical examination revealed swelling of the left lower limb, skin temperature and color, and dorsalis pedis artery. The patient was treated with inferior vena cava filter implantation and heparin anticoagulant before operation. After definite surgical indications, pulmonary artery thrombectomy was performed under general anesthesia and cardiopulmonary bypass. After median thoracotomy induced by general anesthesia, the innominate vein ruptured and bled, followed by circulatory failure and cardiac arrest, and emergency cardiopulmonary bypass was established under intracardiac compression. Pulmonary embolectomy and tricuspid valvuloplasty were performed under cardiopulmonary bypass. After the operation, the patient’s blood coagulation function was poor; 11 pieces of developing gauze were filled in the pericardium to stop bleeding, and chest closure was delayed. The patient died of disseminated intravascular coagulation, hemorrhagic shock, and non-infectious multiple organ dysfunction syndrome early in the morning of the next day. Learning purpose: The etiology and treatment of patients with this kind of pulmonary embolism need to be further discussed.