OBJECTIVE

To analyze symptoms and signs of acute pulmonary embolism (PE) and possibilities of open embolectomy.

MATERIAL AND METHODS

We followed-up 4 patients with embolic occlusion of pulmonary artery by floating thrombi between January 2018 and December 2021. In-hospital PE was diagnosed in 2 patients, intraoperative embolism — in 2 cases. All cases were characterized by circulatory arrest and resuscitation measures before or during emergency surgery. Three patients were preoperatively diagnosed with massive clots in the right cardiac chambers. One patient had paradoxical embolism through a patent foramen ovale into lower limb arteries.

RESULTS

All patients underwent open thromboembolectomy from pulmonary arteries under cardiopulmonary bypass and cold blood cardioplegia. In two patients, we removed floating clots from the right cardiac chambers. In one patient, thrombi from the right chambers migrated into pulmonary artery during induction anesthesia. Two patients died within 30-day period (after 5 days from recurrent PE and after 26 days from multiple organ failure and sepsis). Complications developed in three patients. One patient died in 8 months after intervention from cancer progression. One patient is still alive.

CONCLUSION

Massive embolic occlusion of pulmonary artery is an extremely dangerous cardiovascular disease. All invasive procedures can be effective in only well-equipped hospitals.