Pulmonary embolectomy using normothermic venous inflow occlusion.

The introduction of cardiopulmonary bypass for the urgent removal of massive pulmonary emboli by Sharp (1962) revolutionized the surgical management of this emergency. More patients were successfully treated in the four years following this than in the preceding 50 years since Trendelenburg's (1908) classical description of pulmonary embolectomy. The use of an extracorporeal circulation, and accurate diagnostic methods such as pulmonary angiography and radioactive isotope scanning of the lungs, must be regarded as the ideal. This ideal is difficult to attain in hospitals without the services of staff experienced in open-heart surgery and where facilities to provide a heart-lung machine, primed and ready to use within a very short time, do not exist. There have been many recorded instances of successful pulmonary embolectomy without cardiopulmonary bypass, notably by Allison, Dunnill, and Marshall (1960), who used moderate hypothermia, and by the classical Trendelenburg technique (Kirschner, 1924; Steenburg, Warren, Wilson, and Rudolf, 1958). Vossschulte, Stiller, and Eisenreich (1965) were successful in four out of seven embolectomies using the technique of venous inflow occlusion at normothermia. The following case reports are presented in support of the belief that simple methods of removing massive pulmonary emboli still have a place in circumstances of extreme urgency where more sophisticated techniques are not available.