Acute Myocardial Infarction Caused by Pulmonary Vein Stump Thrombosis after Thoracoscopic Left Upper Lobectomy.

IF 0.7 Q4 SURGERY
Surgical Case Reports Pub Date : 2025-01-01 Epub Date: 2025-01-30 DOI:10.70352/scrj.cr.24-0003
Takahito Fukushima, Masaaki Nagano, Yue Cong, Tatsuki Furusawa, Akihito Saito, Shun Minatsuki, Satoshi Kodera, Norihiko Takeda, Masaaki Sato
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Abstract

Introduction: Pulmonary vein stump thrombosis can sometimes occur at the pulmonary vein stump after lung surgery, possibly causing systemic infarction. Here, we report a rare case of acute myocardial infarction (AMI) caused by pulmonary vein stump thrombosis after the left upper lobectomy.

Case presentation: A 43-year-old male patient with a nodule in the left lingular segment was referred to our hospital. A bronchoscopic biopsy performed at the previous hospital was negative for malignancy; however, the nodule was highly suspicious of primary lung cancer. Therefore, we decided to perform a thoracoscopic lung resection for a definite diagnosis and treatment. Lingular segmentectomy was performed to diagnose the nodule, and a rapid pathological diagnosis confirmed that the nodule was an adenocarcinoma. Subsequently, a left upper lobectomy and systemic lymph node dissection were performed. The left lingular and superior segmental veins were separately dissected using a stapler. The day after the operation, the patient suddenly developed cardiac arrest. Cardiopulmonary resuscitation and venoarterial extracorporeal membrane oxygenation were immediately initiated. After the return of spontaneous circulation was obtained, contrast computed tomography was performed, which suggested thrombosis of the pulmonary vein stump without any signs of brain hemorrhage or infarction. As intermittent ventricular fibrillation persisted, the patient underwent coronary angiography and was diagnosed with AMI due to pulmonary vein stump thrombosis. The thrombosis of the coronary artery was removed using percutaneous coronary intervention. The patient recovered gradually after the intervention and was discharged 2 weeks later from the intensive care unit. One month after rehabilitation for higher brain dysfunction, the patient was discharged from our hospital without any sequelae and received adjuvant chemotherapy for lung cancer.

Conclusions: We encountered a case of AMI caused by pulmonary vein stump infarction after the left upper lobectomy. Given that this complication is rare but lethal, clinicians should consider it and take great care of the residual length of the pulmonary vein stump to prevent thrombosis.

胸腔镜左上肺叶切除术后肺静脉残端血栓致急性心肌梗死。
肺手术后肺静脉残端有时可发生肺静脉残端血栓形成,可能引起全身性梗死。在此,我们报告一例罕见的左上肺叶切除术后肺静脉残端血栓形成引起的急性心肌梗死(AMI)。病例介绍:一位43岁男性患者因左侧舌节结节被转介至我院。在前一家医院进行的支气管镜活检为恶性肿瘤阴性;然而,结节高度怀疑为原发性肺癌。因此,我们决定行胸腔镜肺切除术以明确诊断和治疗。我们进行了舌节切除术来诊断结节,快速的病理诊断证实该结节为腺癌。随后,进行了左上叶切除术和全身淋巴结清扫。分别用吻合器切开左舌静脉和上节段静脉。手术后第二天,病人突然出现心脏骤停。立即开始心肺复苏和静脉动脉体外膜氧合。自发循环恢复后行计算机断层造影,提示肺静脉残端血栓形成,无脑出血及梗死征象。由于间歇性心室颤动持续存在,患者接受冠状动脉造影,并因肺静脉残端血栓形成被诊断为AMI。采用经皮冠状动脉介入治疗去除冠状动脉血栓。患者经干预后逐渐康复,2周后出院。患者因脑部功能障碍康复1个月后,无后遗症出院,接受肺癌辅助化疗。结论:我们遇到了一例左上肺叶切除术后肺静脉残端梗死引起的急性心肌梗死。鉴于这种并发症是罕见的,但致命的,临床医生应该考虑到这一点,并注意残余的肺静脉残端长度,以防止血栓形成。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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