부산대학교 도서관

A 79–year–old man with effort angina was admitted. Coronary angiography showed progressive stenosis of left anterior descending (LAD) artery. Coronary artery bypass grafting without cardiopulmonary bypass was done. The left internal mammary artery (LIMA) graft was anastomosed to LAD. Postoperative transesophageal echocardiography (TEE) detected in the right atrium (RA) a highly mobile structure moving during diastole into the right ventricle. CT scan showed a small pulmonary embolism in the right peripheral pulmonary artery. Thrombolytic therapy was started with heparin and urokinase. Eight days after the beginning of thrombolytic therapy, the clinical status of the patient was quite normal. TEE and CT scan showed no mobile structures in the RA or pulmonary embolism in the pulmonary artery. The LIMA–LAD bypass was patent. He was followed as an outpatient. However, this case was investigated by transthoracic echocardiography (TTE) and TEE simultaneously, as TTE could not detect the thrombus in the RA. As in this case, clinical symptoms such as postoperative slight dyspnea may not be associated with pulmonary embolism, and asymptomatic RA thrombus or small pulmonary embolism may not be detected usually. Evan if heparin was used perioperatively, we should use intermittent pneumatic compression and elastic stockings for the prophylaxis of pulmonary embolism and deep venous thrombus for all cardiovascular surgery patients.