scholarly journals Outcome of surgical embolectomy in patients with massive pulmonary embolism with and without cardiopulmonary resuscitation

2017 ◽  
Vol 4 ◽  
pp. 241-244
Author(s):  
Reza Hajizadeh ◽  
Samad Ghaffari ◽  
Afshin Habibzadeh ◽  
Naser Safaei ◽  
Kamran Mohammadi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiopulmonary Resuscitation ◽  
Massive Pulmonary Embolism ◽  
Surgical Embolectomy

scholarly journals P684 Paradoxical cerebral infarction due to massive pulmonary embolism in extracorporeal cardiopulmonary resuscitation and surgical embolectomy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
H Shiota ◽  
E Kagawa ◽  
M Kato ◽  
N Oda ◽  
E Kunita ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Carotid Artery ◽  
Cardiopulmonary Resuscitation ◽  
Cerebral Infarction ◽  
Massive Pulmonary Embolism ◽  
Paradoxical Embolism ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Surgical Embolectomy ◽  
The Right

Abstract Introduction Paradoxical cerebral infarction is a mechanism of acute ischemic stroke; however, definitive images to diagnose paradoxical embolism are not often obtained. We report a case of paradoxical cerebral embolism complicated with cardiac arrest due to massive pulmonary embolism. Case report A 40-year-old man presented due to sudden-onset chest pain, and was admitted to our hospital. He was restless and had cold sweat; we could not measure blood pressure. Electrocardiography showed wide QRS complex with right bundle branch block, and T wave inversion in leads V1 and III. Transthoracic echocardiography showed diffuse severe left ventricular hypokinesis, with slightly better inferior wall motion compared to other segments. Few minutes after arriving, he experienced cardiac arrest; chest compression was initiated. He was transported to the catheter laboratory, and veno-arterial extracorporeal membrane oxygenation was initiated subsequently. To diagnose the cause of arrest, we performed coronary angiography, which revealed no occluded coronary artery. Pulmonary angiograms showed bilateral proximal pulmonary artery occlusion with massive thrombi (panel A). Surgical embolectomy was performed after cardiac team discussion. After ICU admission post-surgery, pericardial effusion was increased, and the blood drained continuously from the chest tube; a large amount of blood transfusion was required. Reopen chest haemostasis was utilised. After the second ICU admission, anisocoria was observed; subsequent computed tomography showed low density and midline shift in almost the entire left cerebral hemisphere (Panel B). Carotid duplex ultrasound revealed a large thrombus saddled at the left carotid artery bifurcation (Panel C and D). We rechecked the transthoracic echocardiogram at arrival to reveal the cause of the cerebral infarction, which showed the thrombus to be at the ascending aorta (Panel E). We thought that the thrombi had moved from the lower limb to the right atrium. The massive pulmonary embolism increased the pulmonary artery and right atrial pressure, resulting in the lower pressure of the left atrium compared to that of the right atrium. The thrombi passed through the patent foramen ovale into the left atrium, moved into the left ventricle, and embolised the left internal carotid artery (Panel F). He expired due to severe neurologic injury from brain herniation. Conclusion In this case, although the pulmonary embolism was massive and led to cardiac arrest, the deteriorated haemodynamics improved by extracorporeal cardiopulmonary resuscitation and surgical embolectomy. However, we could not rescue the patient because of the severe neurological injury due to paradoxical embolism. Paradoxical cerebral infarction in pulmonary embolism is rare; however, we should pay careful attention to early detection of paradoxical cerebral infarction in pulmonary embolism and treatment for return of the patient to the former lifestyle. Abstract P684 figure

Surgical embolectomy for paradoxical cerebral embolism with massive pulmonary embolism

2019 ◽  
Vol 68 (4) ◽  
pp. 385-388 ◽  
Author(s):  
Kaoru Hattori ◽  
Kazuyuki Daitoku ◽  
Satoshi Taniguchi ◽  
Ikuo Fukuda
Keyword(s):  
Pulmonary Embolism ◽  
Massive Pulmonary Embolism ◽  
Cerebral Embolism ◽  
Surgical Embolectomy

scholarly journals Surgical embolectomy for acute massive pulmonary embolism: state of the art

2018 ◽  
Vol 10 (8) ◽  
pp. 5154-5161 ◽  
Author(s):  
Alessandra Iaccarino ◽  
Giacomo Frati ◽  
Leonardo Schirone ◽  
Wael Saade ◽  
Elio Iovine ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
State Of The Art ◽  
Massive Pulmonary Embolism ◽  
Surgical Embolectomy

scholarly journals Surgical Embolectomy In Massive Acute Pulmonary Embolism: Our Experience

2015 ◽  
Vol 12 (2) ◽  
pp. 83-86
Author(s):  
SV Nemirova ◽  
AP Medvedev ◽  
VV Pichugin ◽  
Krishna Bhandari
Keyword(s):  
Pulmonary Embolism ◽  
Massive Pulmonary Embolism ◽  
Vein Thrombosis ◽  
Medical Academy ◽  
Surgical Embolectomy ◽  
Hospital Deaths ◽  
State Medical Academy ◽  
Deep Vein ◽  
Mean Time

Background and Aims: Pulmonary embolism (PE) is the leading cause of hospital deaths among the non-surgical patients. Our aim was to evaluate the efficacy of surgical embolectomy in massive acute PE.Methods: It was a single centre, prospective study conducted between January 2007 and August 2013 in Specialized Cardiovascular Surgical Hospital of Nizhny Nizhny Novgorod State Medical Academy Nizhny Novgorod, Russia. One hundred and seventy five patients were diagnosed as PE. Only 77 patients were diagnosed as massive pulmonary embolism and were included in this study. Surgical embolectomy was performed without cardiopulmonary bypass through thoracotomy approach only in the involved pulmonary artery. Right atriotomy and evacuation of embolus was done, in cases of right ventricle thrombus.Results: Seventy-seven patients with acute massive PE underwent surgical embolectomy. Four (5.1%) patients died before discharge. Mean time of ICU stay was 70.1±11.0 hours. During six months of follow up after the embolotomy. Eleven (14%) patients had deep vein thrombosis, two had sub-massive PE. During 6 months of follow up 62 patients (81%) had no further episode of venous thrombloembolism.Conclusions: Our study showed surgical embolectomy can be done with good clinical outcome with acceptable mortality rate.Nepalese Heart Journal 2015;12(2):83-86

Pediatric Pulmonary Embolism: Diagnostic and Management Challenges

2016 ◽  
Vol 9 (1) ◽  
pp. 110-113 ◽  
Author(s):  
Christian Lilje ◽  
Aman Chauhan ◽  
Jason P. Turner ◽  
Thomas H. Carson ◽  
Maria C. Velez ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Functional Assessment ◽  
Rare Case ◽  
Three Dimensional ◽  
Massive Pulmonary Embolism ◽  
Pulmonary Angiography ◽  
Computed Tomography Pulmonary Angiography ◽  
Dimensional Reconstruction ◽  
Surgical Embolectomy ◽  
Prophylactic Anticoagulation

A rare case of massive pulmonary embolism is presented in an oligosymptomatic teenager with predisposing factors. Computed tomography pulmonary angiography supported by three-dimensional reconstruction was diagnostic. The embolus qualified as massive by conventional anatomical guidelines, but as low risk by more recent functional criteria. Functional assessment has complemented morphologic assessment for risk stratification in adult patients. Such evidence is scarce in pediatrics. The patient underwent surgical embolectomy, followed by prophylactic anticoagulation, without further events. Diagnostic and management challenges are discussed.

scholarly journals Use of mechanical pulmonary reperfusion and fibrinolysis in acute massive pulmonary embolism requiring extracorporeal membrane oxygenation support: a systematic review and meta-analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
R Chopard ◽  
P Nielsen ◽  
F Ius ◽  
H Pilichowski ◽  
N Meneveau
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
Meta Analysis ◽  
Reperfusion Therapy ◽  
Massive Pulmonary Embolism ◽  
Membrane Oxygenation ◽  
Funding Sources ◽  
Surgical Embolectomy ◽  
Meta Regression ◽  
Va Ecmo

Abstract Background and objectives The optimal pulmonary revascularization strategy in acute massive pulmonary embolism (PE) requiring the implantation extra corporeal membrane oxygenation remains controversial, and data are sparse. Methods We conducted a systematic review and meta-analysis of available evidence regarding the use of mechanical reperfusion (i.e. surgical or catheter-based embolectomy) and fibrinolytic strategies (i.e. systemic fibrinolysis, catheter-directed fibrinolysis, or as stand-alone therapy) in terms of mortality and bleeding outcomes. Results The literature search identified 835 studies, 17 of which were included or a total of 321 PE patients with ECMO. In total, 31.1% were treated with mechanical pulmonary reperfusion, while 78.9% received fibrinolytic strategies. The mortality rate was 23.0% in the mechanical reperfusion group and 43.1% in the fibrinolysis group (Figure). The pooled OR for mortality with mechanical reperfusion was 0.46 (95% CI, 0.213–0.997; I2=28.3%) versus fibrinolysis. The rate of bleeding in PE patients under ECMO was 29.1% in the mechanical reperfusion group and 26.0% in the fibrinolytic reperfusion (OR, 1.09; 95% CI, 0.46–2.54; I2=0.0%) among 10 eligible studies with available bleeding data. The meta-regression model did not identify any relationship between the covariates “more than one pulmonary reperfusion therapy” and “ECMO implantation before pulmonary reperfusion therapy”, and outcomes. Conclusions The results of the present meta-analysis and meta-regression suggest that surgical embolectomy yields the best results, regardless of the timing of VA-ECMO implantation in the reperfusion timeline, and regardless of whether fibrinolysis has been administered or not. FUNDunding Acknowledgement Type of funding sources: None.

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