[A case of pulmonary thromboembolism after cardiac surgery].

It has been reported that pulmonary thromboembolism (PTE) is a major complication in the post-operative period. However, there have been few reports on PTE after cardiopulmonary bypass (CPB). We report a case of PTE that occurred after cardiac surgery using CPB. A 76-year-old female patient underwent aorto-coronary graft bypass and mitral valve plasty because of ischemic heart disease and mitral valve regurgitation, respectively. The results of blood gas analysis after cardiopulmonary bypass showed no abnormalities. Immediately after ICU admission, the oxygenation index (PaO2/FIO2) of the patient was below 100, and the low level persisted despite decrease in interstitial fluid volume of the lung. Evaluations of hemodynamics using ultrasound echography and a Swan-Ganz catheter showed no findings associated with right heart failure. The results of lung perfusion scintigraphy performed on the 6th postoperative day (POD), revealed the decline in radioactivities in the upper and middle lobe areas of the right lung. Urokinase was therefore administered intravenously from the 6th to 9th POD. The oxygenation index increased dramatically after urokinase administration. Although the use of thrombolytic therapy in an early postoperative period is controversial, our patient was successfully treated with urokinase without a life-threatening bleeding tendency.