Background. Intraoperative findings may sometimes complicate a previously planned straight forward operation. This paper reports a case of a patient for mitral valve replacement for mitral stenosis with an intraoperative finding of a large chronic pulmonary embolism and the intra-operative decision made to manage this situation.
Case. We report a case of a 30 year old male patient who has rheumatic mitral stenosis for mitral valve replacement. Intraoperatively, the surgeons found a large chronic embolism occupying approximately 80% of the lumen of the main pulmonary artery, and going towards the right and left pulmonary arteries. He underwent pulmonary endarterectomy, Mitral Valve Replacement and Tricuspid Valve Annuloplasty using a modified De Vega technique.
Conclusions. The case presented is one of those rare cases in which a patient with valvular disease specifically mitral stenosis had an intra-operative finding of chronic pulmonary emboli. The decision of performing a more tedious and critical surgery such as valve replacement with pulmonary endarterectomy was a critical intra-operative decision that could have meant either the patient would benefit dramatically and survive longer or be no better off than his pre-operative state.