[Successful surgical treatment of a massive pulmonary embolism in the organized thromboembolic phase]

A patient, male, aged 36, clinically presented as an unstable angina pectoris following myocardial infarction, who came from general hospital of Banja Luka for further examination is presented. According to the medical report, he was treated for acute myocardial infarction in 1994 at Banja Luka's general hospital, when he was resusciated due to of cardiac arrest. The anginous pain was still present regardless of prescribed therapy. Following the clinical examination at the Military Medical Academy we have established a diagnosis of thromboembolism of the main pulmonary artery with a high pressure in the right ventricle. He underwent surgery under the extracorporeal circulation, when an organized old thrombus the main pulmonary artery and partially in arterial branches. The main pulmonary artery was almost completely obliterated. Thrombectomy was done. Following the operation, the patient was in a good condition and the repeated echocardiographic examinations showed no signs of recurrent thrombosis while the pressure in the right ventricle was significantly decreased. Afterwards, he was treated by heparine and oral anticoagulants and then by antiagregants. This case is very instructive because the massive pulmonary thromboembolism which was wrongly recognized and treated as an acute myocardial infarction.