초록접수 현황
| 20F-040 | Video session발표 |
Surgical Pulmonary Thromboembolectomy with Crisscross Bicaval Cannulation Method
Su Chan Lim¹, Joon Chul Jung², Bongyeon Sohn², Jae Hang Lee², Jun Sung Kim², Cheong Lim², Kay-Hyun Park²
¹Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea, ²Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
Purpose : We report a case of acute massive pulmonary thromboembolism which is successfully treated with surgical pulmonary thromboembolectomy with crisscross bicaval cannulation.
Methods : A 53-year-old man presented on ER due to dyspnea on exertion which started 3 days ago. In the CT scan, bilateral massive pulmonary thromboembolism was confirmed. Emergency operation was planned because his vital sign was unstable and the thrombus was very extensive. The patient was placed in supine position. Under general anesthesia, median sternotomy was done. Aortic cannula was inserted in the high ascending aorta. SVC cannulation was done via RA lateral free wall, and IVC cannulation was performed through RA auricle, to achieve crisscross-fashioned bicaval cannulation, to aid exposure of distal right pulmonary artery. The patient gradually cooled to 20℃. After antegrade cardioplegia perfusion, surgeon moved to left side of the patient. Right pulmonary artery was exposed with Henly retractor. After transverse incision of right pulmonary artery, thromboembolectomy was performed with double-action forceps and Jamieson dissecting aspirator. Incision of the left side was done along main pulmonary artery and left pulmonary artery. After left-sided thromboembolectomy, the patient weaned from CPB with inotropics support because of RV dysfunction. Thrombi were almost fresh, dark-colored, and had some organized portions which were suspicious subacute stage.
Results : The patient was moved to general ward 4 days after surgery, and discharged 8 days after surgery without acute complication.
Conclusion : Acute massive pulmonary thromboembolism is a catastrophic event with high mortality rate. But it may be successfully treated with early surgical intervention in unstable patients.
Methods : A 53-year-old man presented on ER due to dyspnea on exertion which started 3 days ago. In the CT scan, bilateral massive pulmonary thromboembolism was confirmed. Emergency operation was planned because his vital sign was unstable and the thrombus was very extensive. The patient was placed in supine position. Under general anesthesia, median sternotomy was done. Aortic cannula was inserted in the high ascending aorta. SVC cannulation was done via RA lateral free wall, and IVC cannulation was performed through RA auricle, to achieve crisscross-fashioned bicaval cannulation, to aid exposure of distal right pulmonary artery. The patient gradually cooled to 20℃. After antegrade cardioplegia perfusion, surgeon moved to left side of the patient. Right pulmonary artery was exposed with Henly retractor. After transverse incision of right pulmonary artery, thromboembolectomy was performed with double-action forceps and Jamieson dissecting aspirator. Incision of the left side was done along main pulmonary artery and left pulmonary artery. After left-sided thromboembolectomy, the patient weaned from CPB with inotropics support because of RV dysfunction. Thrombi were almost fresh, dark-colored, and had some organized portions which were suspicious subacute stage.
Results : The patient was moved to general ward 4 days after surgery, and discharged 8 days after surgery without acute complication.
Conclusion : Acute massive pulmonary thromboembolism is a catastrophic event with high mortality rate. But it may be successfully treated with early surgical intervention in unstable patients.
책임저자: Jun Sung Kim
²Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
발표자: Su Chan Lim, E-mail : lsc4869@nate.com