Pulmonary Embolism - Policlinico di Monza

Pulmonary Embolism - Policlinico di Monza

Retrograde pulmonary perfusion
improves results of pulmonary
embolectomy for massive pulmonary
embolism
Spagnolo , Tesler, Arone
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Introduction
•  Mortality for pulmonary embolectomy
for massive pulmonary embolism is
reported around 30%, reaching 60% in
the patients that had experienced a
cardiac arrest prior to surgery.
(Gray HH et al. Pulmonary embolism for acute massive
pulmonary embolism: an analysis of 71 cases. BR H J 1988)
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The cause of death
•  We suppose that during pulmonary
embolectomy occur introduction of air
into the pulmonary arterial tree
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Air Embolism
•  Mechanical obstruction and arterial
vasoconstriction
•  Pulmonary hypertension
•  Pulmonary edema
•  Lung injury
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Air Embolism
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Neutrophils aggregation around
air embolus
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Severe hemorrhagic edema
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Changes in pulmonary circulation
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Changes in pulmonary circulation
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Changes in pulmonary circulation
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Retrograde perfusion
•  We have adopted a technique of
retrograde pulmonary perfusion as an
adjunct to standard pulmonary
embolectomy
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Retrograde perfusion
•  Removal of all
air and residual
thrombotic
material from
the pulmonary
arterial
branches
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Clinical experience
•  A consecutive series of 21 severely
compromised patients over a period of
fifteen years
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Patient Population
•  Pts
21
•  Age
35-75 ( mean 55 )
•  Sex
8 M / 13 F
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Diagnosis
•  Had been achieved by pulmonary
angiography and/or by
echocardiography
•  Two patients were taken directly to
the OR from the ward where they had
arrested
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Pathogenesis
•  Thrombophlebit
•  Orthopedic surgery
•  Other surgery
•  Trauma
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7
4
2
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Clinical data
•  Inotrops
19
•  Cardiac arrest in OR
3
•  Cardiac arrest in ward
2
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Treatment
•  Thrombolysis
5
•  Heparine
6
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Echocardiography
•  RV failure
19
•  Parad. movement of sept.
8
•  Thromb in RA
1
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Pulmonary angiography
•  Obstruction >50%
19
•  PAP mean
52+/-14,25
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Results
Cardiac complications
•  Tamponade
•  Pericardial effusion
•  AF
Pulmonary complications
•  Pleural effusion
•  Pneumothorax
1
2
3
2
1
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Mortality
0%
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Conclusions
•  Retrograde pulmonary perfusion may
contribute to decrease mortality and
morbidity in patients undergoing pulmonary
embolectomy for MPE
•  The reason for this is not completely clear.
Possibly, removal of both residual thrombi
and air from the PA tree
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