Emergency Pulmonary Thromboendarterectomy in Malignancy

Pulmonary thromboendarterectomy (PTE) is the treatment of choice for operable chronic thromboembolic pulmonary hypertension, and it is typically planned electively after thorough diagnostic evaluation.

We present the case of a 49-year-old woman with breast cancer who underwent an emergency PTE after presenting with acute-on-chronic pulmonary embolism, acute right ventricular dysfunction, and a thrombus-in-transit via a patent foramen ovale.

Emergency PTE is rarely undertaken owing to complexity, the need for deep hypothermic circulatory arrest, and the high perioperative risk. Moreover, patients with active cancer are generally considered poor surgical candidates. We therefore report this case of an emergency PTE and patent foramen ovale closure in a hemodynamically unstable patient with breast cancer. To the best of our knowledge, this has not been previously documented in the literature.

Emergency PTE can be an effective intervention in selected patients with active malignancy.