Case reportSuccessful Thrombolysis After Pulmonary Endarterectomy
Section snippets
Surgical Procedure
After a median sternotomy, the patient was placed on cardiopulmonary bypass by aortic and bi-caval cannulation. Cardiac arrest was induced with blood cardioplegia, and the patient was cooled to a nasopharyngeal temperature of 18°C. The central pulmonary arteries were opened within the pericardium, and a dissection plane was developed and followed to segmental levels. With 2 periods of circulatory arrest (total, 36 minutes), we achieved desobliteration of six left segmental arteries and all
Postoperative Management
Because of the limited response to hyperventilation and inhaled iloprost, we began additional therapy with intravenous prostacyclin (5 ng/[kg × min]) and performed controlled hemodilution.
Nevertheless, during the first postoperative hours, the patient developed a further increase of her pulmonary artery pressures (PAP, 67/46 [mean, 53 mm Hg]; PVR, 1,111 dyne × sec/cm5), as well as an increasing hemodynamic instability which required marked vasopressor support (0.8 μg/[kg × min] norepinephrine,
Comment
Pulmonary endarterectomy represents the most effective therapeutic option in severe chronic thromboembolic pulmonary hypertension with a drastic improvement in pulmonary hemodynamics and symptoms of heart failure [1, 2, 3]. However, this procedure is associated with a mortality rate of 4% to 23%. Postoperative pulmonary hypertension plays an important role in the occurrence of serious complications, such as reperfusion edema and hemoptysis [4].
In situ thrombosis postpulmonary endarterectomy is
References (7)
- et al.
Pulmonary endarterectomy: experience and lessons learned in 1,500 cases
Ann Thorac Surg
(2003) - et al.
Mechanical fragmentation and pharmacological thrombolysis in massive pulmonary embolism
J Vasc Interv Radiol
(1997) - et al.
Chronic thromboembolic pulmonary hypertension
N Engl J Med
(2001)
Cited by (3)
Interest of echocardiography in the diagnosis and monitoring of a pulmonary embolism complicating a free-floating thrombus in right heart cavities
2012, Annales Francaises d'Anesthesie et de ReanimationManagement dilemmas in acute pulmonary embolism
2014, Thorax