Abstract
We performed pulmonary thromboendarterectomy (PTE) by median sternotomy under deep hypothermia and circulatory arrest in 36 cases of chronic pulmonary thromboembolism (CPTE) associated with pulmonary hypertension during the past 7 years. The patients were 14 males and 22 females aged 21～71 years (mean 50 years). The preoperative condition was NYHA class III in 24 and class IV in 12. Surgery was performed on emergent base in 4 patients. Hypoxemia, marked pulmonary hypertension (mean pulmonary artery pressure 46±9mmHg), and low cardiac output were observed in all patients. Deep vein thrombosis was established in 23 patients. Deep hypothermia (16℃) was induced using cardiopulmonary bypass. PTE was performed as much as possible in the bilateral lungs under intermittent circulatory arrest. 3 patients died due to cardiopulmonary failure and one patient had brain damage in emergent 4 patients. In elective 32 cases, PTE was insufficient in 1 patient with an obstructive lesion in the distal pulmonary artery, and the patient died due to postoperative cardiac failure and respiratory failure after 4 days. One patient died of tracheal bleeding. In the remaining 30 patients, no postoperative reperfusion injury was observed, the arterial blood oxygen concentration improved, and the mean pulmonary arterial pressure decreased to 18±6mmHg. The cardiac output also increased, and NYHA class was improved to I in 15 and II in 15. Concerning the long-term results, marked improvements in the respiratory-cardiac condition were observed and quality of life was improved remarkably in all 30 patients.
