**Author details**

Tomoaki Suzuki\* and Tohru Asai

\*Address all correspondence to: suzukikatuta@yahoo.co.jp

Department of Cardiovascular Surgery, Shiga University of Medical Science, Setatsukinowa, Ootsu, Shiga, Japan

#### **References**


[3] Hagl, C, Ergin, M. A, Galla, J. D, et al. Neurologic putcome after ascending aorta-aortic arch operations; effect of brain protection technique in high-risk patients. J Thorac Cardiovasc Surg (2001). , 121, 1107-21.

**Operative Data Total arch replacement (n=67)**

**(Postoperative Data)**

**Mortality**

Department of Cardiovascular Surgery, Shiga University of Medical Science, Setatsukinowa,

[1] Ergin, M. A, Galla, J. D, Lansman, L, et al. Hypothermic circulatory arrest in operations on the thoracic aorta. Determinants of iperative mortality and neurologic outcome. J

[2] Griepp, R. B, Stinson, E. B, Hollingaworth, J. F, et al. Prosthetic replacement of the aortic

Operative time 156~419 minutes (mean 238 ± 64) CPB time 82-268 minutes (mean 140 ± 36) Coronary ischemic time 38-158 minutes (mean 76 ± 26) Circulatory arrest time 28-137minutes (mean 45 ± 21) SCP time 65-212 minutes (mean 83 ± 29).

Reoperation for bleeding 3 (4%) Deep sternal infection 2 (3%) Permanent stroke 3 (4%) Respiratory failure\* 4 (6%)

30days 0 (0%) Hospital 2 (3%)

\*Requiring prolonged ventilation support of more than 48 hours

and Tohru Asai

\*Address all correspondence to: suzukikatuta@yahoo.co.jp

Thorac Cardiovasc Surg (1994). , 107, 788-97.

arch. J Thorac Cardiovasc Surg (1975). , 70, 1051-63.

CPB = cardiopulmonary bypass

**Table 1.** Operative and Postoperative Data

392 Principles and Practice of Cardiothoracic Surgery

ICU = intensive care unit

**Author details**

Tomoaki Suzuki\*

Ootsu, Shiga, Japan

**References**


**Chapter 17**

**Contemporary Surgical Management of**

Pulmonary embolism (PE) is the most lethal pulmonary condition in the United States and internationally. It is also the third most common cause of death in hospitalized pa‐ tients. Since the introduction of computed tomographic pulmonary angiography (CT-PA), the estimated incidence of PE has risen from 62.1 to 112.3 cases per 100,000 [1]. Untreated, the associated mortality of PE is as high as 30% with recurrent embolism being the most common cause. Globally, systemic anticoagulation is the mainstay of treatment for both chronic and acute PE. In the case of acute massive PE (presenting with hypotension and systolic arterial pressure less than 90 mm Hg) the prognosis is much graver and associat‐ ed with a mortality of 30-60%, second only to sudden cardiac death as a cause of sudden death. This condition mandates a more aggressive and urgent algorithm for diagnosis and treatment. Prompt and appropriate treatment, which may include surgical pulmonary em‐

The history of venous thrombosis and PE is intertwined with landmark developments in the disciplines of anatomy, pathology, hematology, and surgery [2]. While pathologic observa‐ tions of postmortem pulmonary thrombi were detailed by Morgagni [3], Laennec [4], and Cruveilhier [5] in the 18th and 19th centuries, it was not until the late 19th century that the concept of thromboembolism was by recognized by Virchow. Virchow wrote "A plug may extend into the vena cava as thick as the last phalanx of the thumb. These are the thrombi that constitute the source of real danger; it is in them that ensues the crumbling away which

and reproduction in any medium, provided the original work is properly cited.

© 2013 Hui and McFadden; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

**Acute Massive Pulmonary Embolism**

Dawn S. Hui and P. Michael McFadden

http://dx.doi.org/10.5772/53969

bolectomy, can be life-saving.

**2. Historical developments**

**1. Introduction**

Additional information is available at the end of the chapter
