Management of intrapulmonary hemorrhage in patients undergoing pulmonary thrombo-endarterectomy

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.

Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension with bronchial obstruction by a carcinoid tumor

“…Significant pulmonary hemorrhage can occur in 1% of PEA procedures and is associated with a mortality rate of nearly 70%. 7 Although several risk factors have been identified, 2 PA hemorrhage in the absence of PEA is less likely. Additionally, considering the fragile state of the PA even 2 years after a previous PEA, there is a high risk of disastrous events during pulmonary resection in areas where PEA has been performed previously.…”

Peri-Operative Changes of Inflammatory Markers and Their Implications in Pulmonary Endarterectomy

“…Pulmonary hemorrhage is a rare and serious complication and is associated with a mortality rate approaching 70% [ 66 ]. This can be caused by tears or disruption in the intima of the pulmonary artery (surgical struma), bleeding due to the rupture of fragile bronchopulmonary collateral, damage to the blood-airway barrier, and reperfusion pulmonary edema [ 67 ]. Other risk factors correlated with hemorrhage have not been investigated thoroughly.…”