Intraoperative diagnosis and treatment of massive pulmonary embolism complicating surgery on the abdominal aorta.

Massive pulmonary embolism associated with total cardiovascular collapse occurred during the surgical repair of a ruptured abdominal aortic aneurysm with an aortocaval fistula. Pulmonary artery pressure monitoring permitted immediate diagnosis whereas central venous pressures did not reflect the obstruction to right ventricular outflow. Pulmonary embolectomy without cardiopulmonary bypass was performed successfully.