Emergency Lung Surgery for Pulmonary Emboli Reveals Heart Defect
Kim Broll of Cumberland, Maryland lived 58 years without knowing she had a hole in her heart and that one day it would save her life. In fact, it was not until she woke up from emergency surgery to treat massive clots in the blood vessels supplying her lungs that Keshava Rajagopal, MD, PhD, cardiothoracic surgeon at the University of Maryland Heart Center, informed Kim that he had also repaired a heart condition known as patent foramen ovale (PFO). PFO arises when a hole in the upper portion of a fetus’ heart does not close after birth.
Why didn’t Kim know prior to her surgery about her heart condition? Those with PFO who have no other heart problems typically lead a normal life free of symptoms of the condition. PFO is often discovered during an echocardiogram, but the test is usually performed only if a patient presents symptoms of a heart problem.
Kim, a registered nurse, came down with what she thought was bronchitis very shortly after arriving home from a trip to South Carolina. She was taking the antibiotic prescribed by her doctor, but one day she became short of breath. She went to her local emergency room where a CT scan revealed massive pulmonary embolism. It is believed that a large clot originating behind Kim’s left knee, a result of sitting for long periods of time while traveling, traveled to the pulmonary arteries and lodged there. The blood clots blocked the main pulmonary artery and the primary branch to each lung, which are the arteries that provide blood to both lungs. This blockage severely reduced blood flow through Kim’s heart. Acute massive pulmonary embolisms carry a mortality risk of approximately 30% despite treatment.
Kim’s treating doctor recognized the urgency of Kim’s situation – the clots could not only cause damage to her lung tissue, but they could also prevent the rest of Kim’s body from receiving blood and oxygen, which could ultimately lead to organ failure or death. After consulting with the University of Maryland Heart Center team, the decision was made to immediately transport Kim to UMMC by helicopter. Prior to transport, she required high doses of intravenous drugs to support the pump function of the right side of the heart, and maximum levels of mechanical ventilator support for her lungs.
Upon arrival, Kim was immediately wheeled into the operating room to remove the pulmonary emboli. After beginning the procedure, doctors noticed the hole in Kim’s heart. In order to prevent additional blood clots from traveling to other organs later in life for Kim, the surgical team decided to also proceed with repairing the hole.
“Patients in need of pulmonary embolism surgery are frequently referred to the University of Maryland because we are a high volume center for PEs,” said Rajagopal. “We possess the highly trained surgeons and cardiopulmonary bypass equipment needed for this complex operation, and we have technologies to support the heart and/or lungs following surgery if they are not working well. Kim’s case was a little more complicated because of her PFO.” Normal PFO repairs frequently involve stopping the heart while the repair is made. The right side of Kim’s heart was severely dysfunctional, so the decision was made to keep Kim’s heart beating during the repair to prevent further damage.
The operations took place only days after Thanksgiving, and Kim was very thankful that they both were a success. Kim left UMMC a week later. While she is very grateful for the care she received at UMMC, Kim is happy to be back at work - tending to her own patients instead of being one herself.