[Massive pulmonary embolism: case report of successful embolectomy with transatrial vena cava blockade]

Massive pulmonary embolism occurred in a 42-year-old man 7 days after repair of a torn patellar ligament. Because of progressive deterioration in spite of full heparinization and supportive measures, and more than 60% occlusion of the pulmonary vascular bed on angiogram, partial cardiopulmonary bypass was instituted under local anesthesia by femoral artery and vein canulation. After improvement of hemodynamics and tissue oxygenation, general anesthesia was induced, the patient intubated and a longitudinal sternotomy carried out. The superior vena cava was canulated, the inferior vena cava occluded with a tourniquet and the pulmonary artery incised during temporary aortic occlusion. The left main pulmonary artery and its branches were nearly completely occluded, in addition, a large embolus was expressed into the right pulmonary artery by massaging the right lung. Finally, transatrial infrarenal caval interruption with a Mobin-Uddin umbrella filter was carried out. After 48 hours of mechanical ventilation, the patient was extubated; he made an essentially uneventful recovery.