Key result
Emergency embolectomy and delayed PEA rescue a patient with acute PE and underlying CTEPH.
Why the study?
Management strategies for acute pulmonary thromboembolism complicated by underlying chronic thromboembolic pulmonary hypertension require clarification.
Case Report (n=1)
Delayed pulmonary endarterectomy under PCPS support is a viable rescue strategy for acute-on-chronic pulmonary thromboembolism when initial emergency embolectomy is insufficient.
May support delayed PEA under PCPS as rescue in select refractory PTE; hypothesis-generating and requires prospective validation.
症例は46歳男性．肺炎の診断にて他院で入院加療を受けていた．経過中に呼吸苦が増悪し，造影CTで肺動脈内に血栓像を認め，急性肺血栓塞栓症の診断で当院に救急搬送された．経胸壁心エコーで右房内に大きな浮遊血栓を認めたため同日緊急手術を施行し，右房と肺動脈内の新鮮血栓を除去したが，肺動脈内には広範に器質化血栓も認め，基礎に慢性血栓塞栓性肺高血圧症が存在していたことが判明した．肺動脈血栓内膜摘除術（Pulmonary endarterectomy : PEA）の器具の準備がなく，人工心肺から離脱困難であったため，経皮的心肺補助装置（Percutaneous cardiopulmonary support : PCPS）を装着していったん手術を終了した．術後もPCPSから離脱困難であったため，術後5日目にPEAを施行し，人工心肺から離脱可能となった．術後右心カテーテル検査では肺高血圧症を認めず，第22病日に独歩退院となった．
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Niimi et al. (2018) conducted a case report in Acute pulmonary thromboembolism associated with chronic thromboembolic pulmonary hypertension (n=1). Emergency embolectomy and delayed pulmonary endarterectomy was evaluated on Postoperative recovery. Emergency thromboembolectomy followed by delayed pulmonary endarterectomy successfully treated a patient with acute pulmonary thromboembolism and underlying chronic thromboembolic pulmonary hypertension, allowing return to preoperative lifestyle without oxygen support.
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