Chorea in Adults after Pulmonary Endarterectomy with Deep Hypothermia and Circulatory Arrest

摘要

Background: Chronic thromboembolic pulmonary hypertension results from incomplete resolution of vascular obstruction caused by pulmonary thromboembolism. Prognosis is poor if left untreated (1). Pulmonary endarterectomy (PEA) is the therapy of choice for patients with surgically accessible thrombi (1). nnObjective: To describe 5 adult patients in our hospital who underwent PEA and subsequently developed chorea, and to investigate the features associated with the development of chorea. nnMethods: Pulmonary endarterectomy requires median sternotomy, cardiopulmonary bypass, and hypothermic circulatory arrest and was performed according to the University of California, San Diego, protocol (2). The patient is cooled to 20 °C or less in 60 to 90 minutes. Phenytoin (15 mg/kg of body weight to a maximum dose of 1 g) and dexamethasone (1 mg/kg) are administered intravenously. After cross-clamping of the aorta, as the temperature reaches 20 °C, pentothal is administered (500 mg to 1 g) until the electroencephalogram becomes isoelectric. When circulatory arrest is initiated, all lines to the patient are turned off, and the patient is exsanguinated. After a circulatory arrest of up to 20 minutes, reperfusion is done with resumption of cardiopulmonary bypass. Usually, 2 to 4 periods of circulatory arrest are required to perform bilateral endarterectomy.