Sa Young Jo, Choi Si Young, Lee Jong Ho, Kwon Jong Beom, Moon Seok Whan, Jo Keon Hyeon, Wang Young Pil, Kim Seok Chan, Kim Pum Jun, Jung Hae Ok
Department of Thoracic and Cardiovascular Surgery, The Catholic University of Korea, Seoul, Republic of Korea.
Heart Surg Forum. 2007;10(4):E304-8. doi: 10.1532/HSF98.20071043.
Acute major pulmonary artery embolism (AMPE) requires rapid diagnosis and early intensive treatment to optimize patient outcomes. Most patients with AMPE and hemodynamic instability need open pulmonary embolectomy (OPE). We modified the technique of OPE to include a minimally invasive procedure without the use of cardiopulmonary bypass (CPB). From March 1988 to April 2006, we performed OPE on a total of 12 patients (21 sides) with AMPE. Seven patients (13 sides) underwent conventional OPE with CPB and 5 patients underwent off-pump OPE (OPPE), 4 (8 sides) with AMPE and 1 with catheter embolus with thrombosis. In patients who underwent conventional OPE, there was 1 hospital death in a patient with severe right ventricle dysfunction and 2 significant cases of airway bleeding. In patients who underwent OPPE, there was 1 case of minimal airway bleeding. Mean systolic pulmonary artery pressure in conventional OPE and OPPE patients, respectively, decreased from 50.3 +/- 14 mmHg and 35.4 +/- 6.6 mmHg pre-operatively to 41.7 +/- 20 and 28 +/- 3 mmHg postoperatively. During the long-term follow-up, there were 2 cancer-related deaths but no recurrence of PE. All surviving patients maintained functional class I (n = 10) or II (n = 1). Compared with conventional OPE, OPPE was effective for treating AMPE in our selected cases. Modification of conventional CPB and systemic full heparinization to minimal use of systemic heparinization without CPB may be helpful in treating selected patients with AMPE.
急性大面积肺动脉栓塞（AMPE）需要快速诊断和早期强化治疗，以优化患者预后。大多数患有AMPE且伴有血流动力学不稳定的患者需要进行开胸肺动脉栓子切除术（OPE）。我们对OPE技术进行了改良，采用不使用体外循环（CPB）的微创手术。从1988年3月至2006年4月，我们共对12例（21侧）AMPE患者进行了OPE。7例患者（13侧）接受了使用CPB的传统OPE，5例患者接受了非体外循环OPE（OPPE），其中4例（8侧）为AMPE，1例为导管栓子伴血栓形成。接受传统OPE的患者中，1例严重右心室功能不全患者死于医院，2例发生严重气道出血。接受OPPE的患者中，有1例发生轻微气道出血。传统OPE和OPPE患者的平均收缩肺动脉压分别从术前的50.3±14 mmHg和35.4±6.6 mmHg降至术后的41.7±20 mmHg和28±3 mmHg。在长期随访期间，有2例与癌症相关的死亡，但无PE复发。所有存活患者维持心功能I级（n = 10）或II级（n = 1）。与传统OPE相比，OPPE在我们所选病例中对治疗AMPE有效。将传统CPB和全身充分肝素化改为不使用CPB并尽量少用全身肝素化可能有助于治疗部分AMPE患者。
