32 The Annals of Thoracic Surgery Vol 32 No 1 July 1987

propriate setting seems to offer the best hope for survival.

The number of patients in this series is small and, therefore, statistical analysis is inappro- priate, but some conclusions seem warranted from this review. Appropriate diagnostic stud- ies, such as lung scan or pulmonary arterio- gram, should be done as soon as the diagno- sis of pulmonary embolus is entertained. The diagnosis should be established with certainty if at all possible. Once the diagnosis of pulmo- nary embolism is established, the most appro- priate therapy can be chosen. Pulmonary em- bolectomy should be seriously considered if the pulmonary artery pressure is greatly elevated, if more than 50°/o of the pulmonary vasculature is obstructed, or at the first sign of hemodynamic instability. Pulmonary embolectomy should also be undertaken in those patients who ex- perience cardiovascular collapse, in whom a presumptive diagnosis of pulmonary embolism can be made, and who do not respond to the usual measures of cardiopulmonary resuscita- tion. In this last group of patients, immediate

pulmonary embolectomy offers the only hope for salvage.

References 1. Hume M, Sevitt S, Thomas DP: Venous Thrombo-

sis and Pulmonary Embolism. Cambridge, MA, Harvard University Press, 1970

2. Trendelenberg F: Ueber die operative Behandlung der Emboli der Lungenarterie. Arch Klin Chir 86:686, 1908

3. Kirschner M: Ein durch die Trendelenberg Oper- ation geheilter Fall von Emboli der Arterien pul- monalis. Arch Klin Chir 133:312, 1924

4. Gorham LW: A study of pulmonary embolism. Arch Intern Med 108:8, 1961

5. Miller GAH: The diagnosis and management of massive pulmonary embolism. Br J Surg 59:837, 1972

6. Paneth M: Pulmonary embolectomy: an analysis of 12 cases. J Thorac Cardiovasc Surg 53:77, 1967

7. Alpert JS, Smith RE, Ockene IS, et al: Treatment of massive pulmonary embolism: the role of pulmo- nary embolectomy. Am Heart J 89:413, 1975

8. Sasahara AA, Barsamian EM: Another look at pulmonary embolectomy (editorial). Ann Thorac Surg 16:317, 1973

Notice from the American Board of Thoracic Surgery

The American Board of Thoracic Surgery now requires that candidates pass both the written and oral portions of the certifying examination.

In 1980 and thereafter, a written examination will be given prior to the oral examination. It will be necessary to pass the written examina- tion before the oral examination can be taken. The closing date for registration for 1982 is Au- gust 1,1981. The exact times and places of these examinations will be announced later.

A candidate applying for admission to the 1982 certifying examination must fulfill all the requirements for the Board in force at the time the application is received.

Please address all communications to the American Board of Thoracic Surgery, 14640 E Seven Mile Road, Detroit, MI 48205.