Ohte N, Nagao T, Hayakawa K, Hashimoto T, Nakano S, Fujinami T, Ishii T, Hatoh M, Takeda Y, Suzuki Y
3rd Department of Internal Medicine, Nagoya City University Medical School.
Kokyu To Junkan. 1990 Jul;38(7):703-7.
A case report of chronic recurrent pulmonary embolism treated by embolectomy and Günther vena caval filter. A 62-year-old man had suffered from dyspnea on effort for 4 years, and his feeling of dyspnea had gradually increased during the past 3 months. On the day of admission he was in a preshock state, and his pulmonary artery pressure was very high at 90/30 mmHg. Pulmonary blood perfusion scintigraphy showed multiple defects of isotope uptake. Immediately after the scintigraphy, pulmonary embolectomy was performed while using extracorporeal circulation. The operation was successful and his physical activity was markedly improved. After the operation, anti-coagulant and anti-platelet therapies were continued, but recurrence of pulmonary emboli was detected by scintigraphy, and some thrombi were found by venography in deep veins of the lower parts of both legs. To prevent recurrent pulmonary embolism, a Günther vena caval filter was inserted into the inferior vena cava. We considered this case as an acute worsening of chronic recurrent pulmonary embolism and we had the impression that pulmonary embolectomy is a very effective therapeutic method for serious pulmonary embolism, and that insertion of the Günther vena caval filter is a very easy and safe procedure.
1例慢性复发性肺栓塞行栓子切除术及置入冈瑟下腔静脉滤器的病例报告。一名62岁男性劳力性呼吸困难4年，近3个月呼吸困难感逐渐加重。入院当天处于休克前期，肺动脉压高达90/30 mmHg。肺血流灌注显像显示多处同位素摄取缺损。显像后立即在体外循环辅助下行肺栓子切除术。手术成功，其体力活动明显改善。术后继续抗凝和抗血小板治疗，但显像检查发现肺栓塞复发，下肢深静脉静脉造影发现一些血栓。为预防复发性肺栓塞，在下腔静脉置入冈瑟下腔静脉滤器。我们认为该病例为慢性复发性肺栓塞急性加重，我们认为肺栓子切除术是治疗严重肺栓塞的非常有效的治疗方法，而置入冈瑟下腔静脉滤器是一种非常简便且安全的操作。
