Korean J Anesthesiol.  2003 Dec;45(6):797-801. 10.4097/kjae.2003.45.6.797.

Thromboendarterectomy in a Patient with Unilateral Chronic Thromboembolic Pulmonary Hypertension

• Suh JH
• Park JH
• Jeon YS
• Kim JH
• Ham BM
• Kim YL

• KMID: 2039752
• DOI: http://doi.org/10.4097/kjae.2003.45.6.797

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is considered to be an aberrant outcome of acute pulmonary thromboembolism, due to inadequate thrombus dissolution. However, the mechanism of thrombi dissolution failure remains unclear. With respect to inherited thrombophilia, the co-occurrence of natural anticoagulant deficiencies with CTEPH was found to be rare. Pulmonary thromboendarterectomy (PTE) is a potentially curative surgical procedure for CTEPH, but it is associated with considerable mortality due to postoperative complications, such as reperfusion pulmonary edema and right heart failure. The postoperative course after PTE poses a unique series of ventilatory care and hemodynamic management challenges. We present the case of a 42-year-old woman with unilateral CTEPH combined with thrombophilia (Protein S deficiency). Successful PTE was followed by independent lung ventilation with unilateral nitric oxide (NO) inhalation, which resulted in functional improvement without postoperative complications.

Keyword

chronic thromboembolic pulmonary hypertension; pulmonary thromboendarterectomy; protein S deficiency; reperfusion pulmonary edema

MeSH Terms

Adult
Endarterectomy*
Female
Heart Failure
Hemodynamics
Humans
Hypertension, Pulmonary*
Inhalation
Lung
Mortality
Nitric Oxide
Postoperative Complications
Protein S Deficiency
Pulmonary Edema
Pulmonary Embolism
Reperfusion
Thrombophilia
Thrombosis
Ventilation
Nitric Oxide