[Successful direct embolectomy for acute massive pulmonary thromboembolism]

A 35-year-old woman was bedridden because of a fall and developed pulmonary embolism after venous thromboembolism of lower extremity. Although anticoagulation therapy was immediately carried out, hemodynamics deteriorated gradually into the state of class IV in Green-field's classification. As a result, an urgent surgical procedure was performed. Under moderate hypothermic cardio-pulmonary bypass, the aorta was cross-clamped and the pulmonary artery was opened. An 18 gram clot was taken out directly and other small pieces of clot were removed with a fiberscope, a Fogarty catheter and an aspirating tube. After surgery the patient recovered from symptoms efficiently. Some cases of acute pulmonary thromboembolism have been reported, however, the generalized classification and surgical indication for this disease have not been established yet. But, as all of reports mentions, surgical procedure is recommended positively to these cases that resist anticoagulation therapy.