The Journal of Thoracic and Cardiovascular Surgery, Vol 76, 620-628, Copyright © 1978 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Surgical correction of chronic postembolic obstructions of the pulmonary arteries
C Cabrol, A Cabrol, J Acar, I Gandjbakhch, G Guiraudon, L Laughlin, MF Mattei, P Godeau and P Grondin
Following episodes of pulmonary embolism, the presence of thrombi in the
pulmonary arteries leads to severe respiratory insufficiency and chronic
right heart failure. We have operated upon 16 such patients, nine men and
seven women from 23 to 68 years of age. All had severe dyspnea, 14 had
chronic cor pulmonale, six had mental disturbances with syncope, and four
had severe cardiac failure. The presence of clots was demonstrated by
pulmonary angiography, and the permeability of the distal arterial bed was
ascertained by selective injection of the bronchial arteries. In all cases
but two a lateral thoracotomy was used so that the obstructed arterial
branches could be approached distally. The inferior vena cava was always
ligated to prevent recurrences. There were six operative deaths, three from
cardiac failure, one from acute pulmonary edema, one from hemothorax, and
one following a pyothorax. Ten patients are surviving after 6 months to 10
years. One is still limited because of significant pleuropulmonary
sequelae. Six are enjoying good results with marked improvement in their
functional limitations, a significant drop in the pulmonary artery
pressure, and radiological permeability of previously obstructed arteries.
Three are excellent condition--completely asymptomatic.
