![]() 9 The use of a filter is currently indicated in patients with PTE and a contraindication for anticoagulation and in patients with PTE despite anticoagulation therapy. When anticoagulant therapy is given, recurrence after embolectomy is below 5%. The use of a vena cava filter is controversial. Sadeghi et al 8 has advocated the use of RV assist if necessary. In our patient, although the thrombus was removed within 20 min, 5 hours of assist were needed for the RV to recover slightly. Surgery may be prolonged due to the need for RV assist. 6 Echocardiography currently allows rapid, efficient diagnosis of PTE. 4Įarly diagnosis is needed to prevent irreversible damage, since 70% of patients with acute PTE die within the first hour. At present, preoperative cardiac arrest, which occurs rather often during anesthesia induction, 5 is considered to be the greatest indicator of surgical mortality. Leacche et al 4 described 47 patients and mortality of 6% in a series in which only 32% of patients presented RV dysfunction and only 11% had presented cardiac arrest. Meneveau et al 3 pointed out that surgery provides greater benefits in patients with acute PTE who do not respond to thrombolytics. Gulba et al 2 found a similar mortality between the medically treated group and the surgical group, but with a lower incidence of recurrence in the latter (21% vs 7.7%). Sodium heparin therapy was started and she was extubated on day 10 and discharged after 1 month with no sequelae.įibrinolysis is the treatment of choice in acute PTE, 1 although an increasing number of cases are treated by surgery. In the intensive care unit (ICU), the patient improved hemodynamically, and the sternotomy was closed on the third day. Thrombi removed from the pulmonary artery trunk and both pulmonary arteries.
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