Catastrophic Cardiac Arrest Caused by Acute Pulmonary Hypertension After Removal of Giant Left Atrial Thrombus

Abstract

<i>Background</i>: Pulmonary hypertension (PH) is defined as a resting mean pulmonary arterial pressure (mPAP) >20 mmHg on right heart catheterization, as described in the proceedings of the 6<sup>th</sup> World Symposium on Pulmonary Hypertension. Left-sided heart failure (left heart disease) is the most common cause of pulmonary hypertension (PH). Transesophageal echocardiography (TEE) plays an important role in the monitoring of PH. But the disadvantage of TEE is the lack of continuity of monitoring. For patients with severe mitral stenosis and severe PH, should the Swan-Ganz catheter be placed routinely? The monitoring of pulmonary artery pressure and pulmonary venous pressure by Swan-Ganz catheter can guide the management of perioperative circulation and respiration, especially for early detection of PH. <i>Case presentation</i>: This case report introduce a severe mitral valve stenosis with giant left atrium thrombosis performing cardiac surgery. After the removal of giant left atrial mass and mitral valve replacement under cardiopulmonary bypass (CPB), the patient gradually experienced difficulty in ventilation and persistent refractory hypotension, followed by ventricular fibrillation during the process of chest closure. <i>Conclusions</i>: TEE helps diagnose acute pulmonary hypertension. Although TEE plays an important role in the diagnosis and the decision to use mechanical devices, a Swan-Ganz catheter would be an effective hemodynamic monitoring device and can be used in conjunction with TEE in cardiac surgery.