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Korean Journal of Anesthesiology 2003;45(6):797-801.
DOI: https://doi.org/10.4097/kjae.2003.45.6.797   
Thromboendarterectomy in a Patient with Unilateral Chronic Thromboembolic Pulmonary Hypertension.
Jeong Hun Suh, Ji Hyun Park, Yun Seok Jeon, Jin Hee Kim, Byung Moon Ham, Yong Lak Kim
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea. hambm@snu.ac.kr
Chronic thromboembolic pulmonary hypertension (CTEPH) is considered to be an aberrant outcome of acute pulmonary thromboembolism, due to inadequate thrombus dissolution. However, the mechanism of thrombi dissolution failure remains unclear. With respect to inherited thrombophilia, the co-occurrence of natural anticoagulant deficiencies with CTEPH was found to be rare. Pulmonary thromboendarterectomy (PTE) is a potentially curative surgical procedure for CTEPH, but it is associated with considerable mortality due to postoperative complications, such as reperfusion pulmonary edema and right heart failure. The postoperative course after PTE poses a unique series of ventilatory care and hemodynamic management challenges. We present the case of a 42-year-old woman with unilateral CTEPH combined with thrombophilia (Protein S deficiency). Successful PTE was followed by independent lung ventilation with unilateral nitric oxide (NO) inhalation, which resulted in functional improvement without postoperative complications.
Key Words: chronic thromboembolic pulmonary hypertension; pulmonary thromboendarterectomy; protein S deficiency; reperfusion pulmonary edema


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