Pulmonary embolism: a frequent cause of acute fatality after lung resection

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Abstract
Between 1975 and 1993, lung resections were performed in 1735 patientsbecause of malignancies, with an early postoperative mortality of 7.2% (125patients). Early postoperatively acute cardiorespiratory failure wasexperienced by 32 patients (1.85%), of whom 26 died despite immediateresuscitation measures. In 20/26 patients autopsy was performed revealingcentral pulmonary embolism as the cause of death in 19 of them. In onepatient a rupture of the free posterior left ventricular wall followingtransmural myocardial infarction was found. Two patients who could beresuscitated successfully were operated on with extracorporeal circulationafter pulmonary angiography had been performed to confirm the diagnosis;however they died 2 days later of right heart failure. Of the survivorsthree cases had myocardial infarctions, one patient had arrhythmias ofunknown etiology. Immediate embolectomy with the use of extracorporealcirculation was performed in two patients, only on the ground of suspectedpulmonary embolism and without further diagnostic measures. Both patientssurvived. Of the 23 cases, with proven pulmonary embolism 17 were stillunder postoperative prophylaxis with heparin. Six patients were alreadyfully mobilized. We conclude that massive pulmonary embolism is a frequentearly postoperative fatal complication after lung resections, which cannotbe safely prevented by postoperative heparinization. The only successfullife-saving measure in the case of central pulmonary embolism is immediatepulmonary embolectomy, if necessary without further diagnosticmeasures.

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