A case of adenocarcinoma of the lung complicated with chronic thromboembolic pulmonary hypertension that underwent upper pulmonary lobectomy

Background. Pulmonary hypertension is a known risk factor of perioperative complications, but the risks of non-cardiac operations have not been examined sufficiently. Case. A 68-year-old man was found to have chronic thromboembolic pulmonary hypertension and adenocarcinoma of the upper lobe of the left lung. Anticoagulation therapy was started and video-assisted thoracoscopic left upper lobectomy was performed on the lung carcinoma because of thrombi in the pulmonary artery trunk had disappeared, together with reduced pulmonary arterial pressure (PAP) on cardiac echography. After anesthesia, severe pulmonary hypertension (mean PAP > 40 mmHg) became obvious on right heart catheterization. Following surgery, pulmonary hypertension continued, and anticoagulation and combination therapy with sildenafil and bosentan was started. Exercise tolerance improved and the patient was discharged under long-term oxygen therapy 30 days after the operation. Conclusion. Sildenafil and bosentan were effective for pulmonary hypertension after pulmonary lobectomy. Further research with a large-scale study is recommended.