Which procedure corrects acidic cor pulmonale?

• A. Atrial septostomy
• B. Pneumonectomy
• C. Lobectomy
• D. Pulmonary embolectomy

Answer: (D)

The key idea is addressing the cause of right heart strain and poor gas exchange that leads to acidosis in cor pulmonale. When the right ventricle is failing because of an obstruction in the pulmonary arteries—such as a massive pulmonary embolism—the quickest way to reverse the acidemia is to remove that obstruction. Pulmonary embolectomy directly clears the emboli from the pulmonary arteries, immediately reducing the pulmonary vascular resistance, improving blood flow through the lungs, enhancing oxygen uptake and carbon dioxide removal, and thereby correcting the acidosis.

Creating an atrial septal shunt can decompress the right heart in severe pulmonary hypertension, but it worsens systemic oxygenation by letting deoxygenated blood bypass the lungs, and it doesn’t fix the underlying obstruction or the acute gas-exchange failure here. Removing lung tissue through pneumonectomy or lobectomy doesn’t resolve the embolic blockage and can worsen overall gas exchange or pulmonary hemodynamics. So the procedure that best corrects the acid-base disturbance by addressing the root cause is pulmonary embolectomy.