Surgical embolectomy for high-risk AMPE patients has an excellent operative mortality and long-term outcome. Preoperative PCPS may lead to an immediate stable haemodynamic state and improve surgical embolectomy results, especially in high-risk patients (e.g. those with preoperative CPA). Surgical embolectomy for AMPE is an established operation and considered as the first-line therapy.

Primary cardiac tumors are rare. Myxoma is the most common type of benign cardiac tumor and papillary fibroelastoma PFE is the second most common. We report a case of coexisting left atrial myxoma and aortic valve PFE. A 77-year-old Japanese woman with a left atrial mass was referred to our hospital for further diagnostic evaluation and surgical treatment. The mass was detected by coronary computed tomography, which was performed by her general practitioner. Investigation with an echocardiogram revealed a mass on the fossa ovalis, extending into the left atrium. Intraoperative transesophageal echocardiography TEE showed another mass attached between the left coronary cusp LCC and the right coronary cusp of the aortic valve. After cardiopulmonary bypass and cardioplegic arrest, we performed an aortotomy, and observed the aortic valve. We found a mobile mass on the LCC and resected it. After left atriotomy, a left atrial myxoma was identified and resected, together with its margin. Postoperatively, sinus bradycardia, sinus pauses, and atrial fibrillation tachycardia were identified. Therefore, we implanted a permanent pacemaker on the 29th postoperative day. The patient was discharged on the 38th postoperative day. Simultaneous existence of two different primary cardiac tumors is rare. We believe that preoperative and intraoperative TEE in patients with cardiac tumors is important.

急性肺動脈血栓塞栓症(APTE)は急激な経過をたどる場合があり当院では積極的に外科的血栓摘除を行っTreatment of acute pulmonary thromboembolism(APTE)in patients with hemodynamic instability still remains controversial. We analyzed the outcome and validity of surgical pulmonary embolectomy for APTE. Between January of 2004 to December of 2010, 15 patients underwent emergency surgical pulmonary embolectomy using cardiopulmonary bypass with beating heart. Our operative indications were ; within 7 days from onset, hemodynamic instability, bilateral pulmonary artery obstruction or unilateral obstruction with central clot and right ventricular dysfunction. Ten patients presented in cardiogenic shock, two of whom showed cardiac arrest and required cardiopulmonary resuscitation before operation. One patient required percutaneous cardiopulmonary support. Median follow up period is 33 months(range 3 to 86 months). All patients survived the operation, but 3 patients died in the hospital on post operative day 11(massive cerebral infarction), day 18(brain hypoxia)and day 25 (multiorgan failure). Two of them had cardiac arrest and received cardiopulmonary resuscitation before operation. Hospital mortality was 20%. And all patients left the hospital on foot except one patient who had been bedridden by myotonic dystrophy before operation. No patients died or showed symptoms of pulmonary hypertension after discharge. Prompt diagnosis and surgical pulmonary embolectomy before threatening fatal condition improves the outcome of embolectomy. Jpn. J. Cardiovasc. Surg. 41 : 58-62