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Successfully operated case of recurrent pulmonary thromboembolism with disabling chronic cor pulmonale Katsuhiro Yamamoto 1 , Shumpei Okubo 1 , Masahiro Naito 1 , Takashi Fujii 1 , Katsuhiko Hiramori 1 , Takeyoshi Kunieda 1 , Takao Yoshioka 2 , Motomi Ando 3 , Shigeaki Uemura 3 , Nobuyuki Nakajima 3 1Division of Cardiology,National Cardiovascular Center 2Research Institute, National Cardiovascular Center 3Division of Vascular Surgery, National Cardiovascular Center pp.565-570
Published Date 1986/5/15
DOI https://doi.org/10.11477/mf.1404204875
  • Abstract
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A successfully operated case of recurrent pulmonary thromboembolism with disabling chronic cor pulmonale was reported. A 39-year-old man with dyspnea and chest pain on exertion for four years was admitted to our hospital. A marked jugular vein distension, a prominent P2, and a Grade 3/6, soft holosystlic tricuspid regurgi-tant murmur were noted. The liver was palpated 4. 5cm below the right costal margin. Chest X-ray film showed mild cardiomegaly and the lung vascularity was decre-ased in the right lung. ECG demonstrated abnormal Q waves in III, and aVF, and ST segments were depressed in V2~4, and T waves were inverted in leads II, III, aVF, and V1~6. A perfusion lung scan revealed that the blood How to the right middle and lower lung was totally absent, and several areas of perfusion defects were also observed in the left lung. Right-sided cardiac catheterization revealed that the PA pressure was 75/15 mean 57) mmHg, and the CO was 2.6L min. Pul-monary arteriogram demonstrated complete occlusion of the right middle and lower lobe arteries and partial occlusion of the left pulmonary arteries. Right pulmon-nary arteries distal to the occluded segments were found to be patent and filled by collaterals from the right coronary artery and bronchial artery. Pulmonary embo-lectomy was performed. Large, organized, adherent thrombi were found and removed from the right main PA as well as from middle and lower lobe branches.After operation, his exercise capacity markedly improved with significant fall in the PA pressure. Post operative pulmonary angiogram confirmed the re-establishment of the blood flow in the right lung.

This case indicates that there exist some cases of recurrent pulmonary thromboembolism in whom surgi-cal operation can dramatically improve their conditions.


Copyright © 1986, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1200 印刷版ISSN 0452-3458 医学書院

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