Summary

This report concerns the case of a patient who had suffered a massive pulmonary embolus and for whom, despite immediately administered thrombolytic therapy with rt-PA it became necessary to initiate reanimation procedures. The patient was subsequently admitted to our cardiac surgery clinic for the purpose of operative intervention. After femorofemoral coupling on the heart-lung machine, right ventricular relieve was rapidly attained. During the course of a 3-hour period of extracorporal circulation, the initially significantly elevated pulmonary pressures were able to be reduced to moderate levels. Correspondingly, right ventricular recovery could be echocardiographically determined. As a consequence of this development, and after preclusion the presence of any large thrombotic masses which might have been situated in the pulmonary trunk, it was possible to forego thoracotomy and embolectomy. This procedure allowed, on the one hand, the avoidance of imminent right ventricular failure through the use of the heart-lung machine. On the other, due to the lessening of the degree of surgical intervention, the risk of grave hemorrhaging as a result of concurrent thrombolytic therapy could be minimalized. After an uneventful course, the patient was able to be transferred on the second postoperative day with normal pulmonary pressure values.