Management of intrapulmonary hemorrhage in patients undergoing pulmonary thrombo-endarterectomy

Ann Card Anaesth. 2021 Jul-Sep;24(3):384-388. doi: 10.4103/aca.ACA_191_20.

Abstract

Massive pulmonary hemorrhage during pulmonary thromboendarterectomy (PTE) can be managed by a conservative approach with mechanical ventilatory support, positive end-expiratory pressure, lung isolation, reversal of heparin, and correct of coagulopathy. We present three challenging cases that developed intrapulmonary hemorrhage during/after PTE and managed successfully. The first patient had bleeding from the bronchial artery and right internal mammary collaterals, which was managed by coil-embolization. The second patient had a breach in the blood airway barrier in the right upper lobar segment of the lung, and the repair was done using a surgical absorbable hemostat. The third patient developed reperfusion injury, he was instituted on veno-venous extracorporeal membranous oxygenation, a week later, the patient recovered completely. An algorithm was adopted and modified to our requirements; all the 3 challenging intrapulmonary hemorrhage cases were successfully managed. This algorithm can be used for satisfactory outcomes in patients who suffer intrapulmonary hemorrhage during PTE.

Keywords: CTEPH; Chronic thromboembolic pulmonary hypertension; PTE; pulmonary hemorrhage; pulmonary thromboendarterectomy.

Publication types

  • Case Reports

MeSH terms

  • Chronic Disease
  • Endarterectomy
  • Hemorrhage / etiology
  • Hemorrhage / therapy
  • Humans
  • Hypertension, Pulmonary*
  • Infant, Newborn
  • Lung
  • Male
  • Pulmonary Artery
  • Pulmonary Embolism* / complications
  • Pulmonary Embolism* / diagnostic imaging
  • Pulmonary Embolism* / surgery