Management of intrapulmonary hemorrhage in patients undergoing pulmonary thrombo-endarterectomy

Muralidhar Kanchi, Hema Nair, Pooja Natarajan, Julius Punnen, Varun Shetty, Sanjay Patangi, Deviprasad Shetty, Kumar Belani

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)384-388
Number of pages5
JournalAnnals of Cardiac Anaesthesia
Volume24
Issue number3
DOIs
StatePublished - Jul 17 2021

Bibliographical note

Publisher Copyright:
© 2021 Wolters Kluwer Medknow Publications. All rights reserved.

Keywords

  • CTEPH
  • Chronic thromboembolic pulmonary hypertension
  • PTE
  • pulmonary hemorrhage
  • pulmonary thromboendarterectomy

PubMed: MeSH publication types

  • Case Reports

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