Acute Myocardial Infarction Caused by Pulmonary Vein Stump Thrombosis after Thoracoscopic Left Upper Lobectomy

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INTRODUCTION: Pulmonary vein stump thrombosis can sometimes occur at the pulmonary vein stump after lung surgery, possibly causing systemic infarction. Here, we report a rare case of acute myocardial infarction (AMI) caused by pulmonary vein stump thrombosis after the left upper lobectomy.

CASE PRESENTATION: A 43-year-old male patient with a nodule in the left lingular segment was referred to our hospital. A bronchoscopic biopsy performed at the previous hospital was negative for malignancy; however, the nodule was highly suspicious of primary lung cancer. Therefore, we decided to perform a thoracoscopic lung resection for a definite diagnosis and treatment. Lingular segmentectomy was performed to diagnose the nodule, and a rapid pathological diagnosis confirmed that the nodule was an adenocarcinoma. Subsequently, a left upper lobectomy and systemic lymph node dissection were performed. The left lingular and superior segmental veins were separately dissected using a stapler. The day after the operation, the patient suddenly developed cardiac arrest. Cardiopulmonary resuscitation and venoarterial extracorporeal membrane oxygenation were immediately initiated. After the return of spontaneous circulation was obtained, contrast computed tomography was performed, which suggested thrombosis of the pulmonary vein stump without any signs of brain hemorrhage or infarction. As intermittent ventricular fibrillation persisted, the patient underwent coronary angiography and was diagnosed with AMI due to pulmonary vein stump thrombosis. The thrombosis of the coronary artery was removed using percutaneous coronary intervention. The patient recovered gradually after the intervention and was discharged 2 weeks later from the intensive care unit. One month after rehabilitation for higher brain dysfunction, the patient was discharged from our hospital without any sequelae and received adjuvant chemotherapy for lung cancer.

CONCLUSIONS: We encountered a case of AMI caused by pulmonary vein stump infarction after the left upper lobectomy. Given that this complication is rare but lethal, clinicians should consider it and take great care of the residual length of the pulmonary vein stump to prevent thrombosis.