Hojo Ryuji, Idota Takeshi, Saga Toshifumi, Motoharu Yosuke, Urata Masahiro, Okazaki Yukio
Department of Cardiovascular Surgery, Shin-kuki General Hospital, Kuki, Japan.
Kyobu Geka. 2020 Aug;73(8):623-626.
A state in which thrombus is found in both right and left atria with thrombus penetrating the foramen ovale is called as impending paradoxical embolism (IPE). A 42-year-old man was found to have poor oxygenation and shock when his body was turned prone after induction of anesthesia. We inserted percutaneous cardiopulmonary support (PCPS), and his blood pressure was maintained. Transesophageal echocardiography revealed right heart pressure overload and left atrial thrombus. Computed tomography (CT) showed thrombosis in both main pulmonary arteries. The patient was judged to require emergency surgery. Bilateral pulmonary artery thrombus and thrombus between the right and left atria was removed under hypothermia using a heart-lung machine. Postoperatively, thrombus was detected in the bilateral posterior tibial vein and peroneal vein. He had a good postoperative course. There were few reports of IPE with pulmonary embolism that developed during operation.
在左右心房均发现血栓且血栓穿透卵圆孔的状态被称为濒发性矛盾栓塞（IPE）。一名42岁男性在麻醉诱导后身体转为俯卧位时出现氧合不良和休克。我们插入了经皮心肺支持（PCPS），维持了他的血压。经食管超声心动图显示右心压力过载和左心房血栓。计算机断层扫描（CT）显示双侧主肺动脉血栓形成。该患者被判定需要紧急手术。在低温下使用心肺机清除了双侧肺动脉血栓以及左右心房之间的血栓。术后，在双侧胫后静脉和腓静脉中检测到血栓。他术后恢复良好。关于术中发生肺栓塞的IPE报道很少。
