Management of a pulmonary artery embolectomy and recurrent embolus

Pulmonary emboli are complex syndromes of altered coagulation and perfusion that remain prevalent among the population, especially the hospitalized. Adequate preparation by the clinicians and realization of the subtle yet potentially catastrophic nature of pulmonary emboli are critical when surgical intervention is required. This case report describes a 49-year-old woman with a diagnosis of massive pulmonary embolism who was brought to the operating room for emergent pulmonary artery embolectomy. Despite a profound Venouobstruction in her main pulmonary artery, she arrived in no acute distress and with stable hemodynamic values. During induction of general anesthesia, she quickly decompensated, requiring emergent cardiopulmonary bypass. Intraoperative transesophageal echocardiography guided the multistep surgery, resulting in the recognition of a recurrent right atrial embolus. The patient tolerated the procedure and ultimately had a favorable hospital course.