Massive pulmonary embolism after off-pump coronary artery bypass surgery.

An 88-year-old woman developed an acute massive pulmonary embolism after off-pump coronary artery bypass surgery. She experienced dyspnea while walking on the sixth day after operation. Her chest radiograph showed pleural effusion. Initially, she was treated for heart failure due to bypass graft occlusion. A repeat echocardiogram revealed enlargement of the right ventricle. Multislice computed tomography showed a massive embolus in the pulmonary artery. Surgical embolectomy was performed, and her postoperative course was easy. Recently, the incidence of pulmonary embolism in Japanese people has been rising. In addition, widespread implementation of off-pump coronary artery bypass compromises the protective effect against pulmonary embolus after cardiac surgery. Although the incidence of pulmonary embolism after coronary artery bypass surgery is still low in Japan in comparison to that in Western countries, prophylaxis against pulmonary embolism after off-pump coronary artery surgery is becoming more important.