Marchioro, TL and Hermann, G and Waddell, WR and Starzl, TE
(1964)
Pulmonary embolectomy in a patient with recent renal homotransplantation.
Surgery, 55 (4).
505 - 510.
ISSN 0039-6060
Abstract
A successful case of pulmonary embolectomy is described. Diagnosis was made when the patient developed cardiac arrest in the hospital ward. The embolus was removed with the aid of cardiopulmonary bypass. The principal clot was discovered in the right pulmonary artery, with an additional small fragment in the left main pulmonary artery. Several unique features of this case increased the problems of care during and after the embolectomy. The patient had received a renal homotransplant to the left iliac fossa from a patient of a different blood type 7 weeks earlier. The embolus was thought to have originated in the left leg distal to the renal vein anastomosis. Technical details of the cardiopulmonary bypass and the subsequent vena caval plication were planned with a view to protecting the function of the graft. The presence of the renal homograft may have contributed to the original formation of the peripheral thrombus. Finally, the postoperative care was complicated by the need to provide cytotoxic drug therapy for the continued protection of the homograft. This therapy, which weakens the immunologic response of the host, had to be modified when septic complications occurred during the postoperative period. Eventual recovery was possible with minimal loss of renal function. © 1964.
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