Introduction: February 2005 was a patient treated for AMPE at Ullevål University hospital with open pulmonary embolectomy. Surgery was used as a last resort when other treatment failed. What are the indications for open pulmonary embolectomy? Should AMPE be operated? We present a case report and a literature study of 1) Diagnostics, 2) Epidemiology, 3) Pathophysiology and 4) Treatment of AMPE. Methods: We have searched PubMed and The Cochrane Library for relevant articles. The Norwegian Patient Registry, Statistics Norway and the patient registry at Ullevål University hospital has been used for epidemiology.Results: CT is now the first choice for the diagnosis of PE. Echocardiography can identify RV dysfunction, indicating AMPE. In 2004, 3652 patients in Norway got the diagnosis pulmonary embolism, 406 of these had AMPE. The same year 184 patients had pulmonary embolism as cause of death. AMPE causes right ventricular failure and decrease of left ventricular preload due to increased pulmonal resistance. This gives a reduction of cardiac output. There is also seen hypoxaemia. Treatment options are trombolysis, different interventional radiology techniques and surgery with open pulmonary embolectomy. In 2004, one patient with AMPE were operated.Discussion: Trombolysis is normally used as the first treatment option. There are no randomized controlled studies comparing surgery, trombolysis or catheter techniques. Recent studies show good results with surgery. Indications for surgery are serious hemodynamic instability with RV dysfunction, contraindications to trombolysis or failed trombolysis. Conclusion: We believe there is an underuse of surgery in the treatment for AMPE in Norway. Early surgical intervention may improve overall survival. To accomplish this, patients with AMPE should be evaluated by an interdisciplinary team including surgeons.