Massive Pulmonary Hemorrhage Following Pulmonary Endarterectomy

Abstract

Perioperative reperfusion injury, acute right heart failure, and massive pulmonary hemorrhage are the most important factors determining mortality following pulmonary endarterectomy operation (PEA). Our approach for the treatment of intraoperative pulmonary hemorrhage following pulmonary endarterectomy is discussed. We retrospectively studied a PEA case with massive pulmonary hemorrhage that occurred in 2017. We used endobronchial blocker to ensure that the bleeding is stopped and used extracorporeal membrane oxygenation (ECMO) for respiratory and hemodynamic requirements. ECMO is a good alternative for most of the pre- and postoperative major complications of PEA. Combined use of endobronchial blocker and ECMO could be a useful treatment method for massive pulmonary hemorrhage following pulmonary endarterectomy.

Keywords

• PEA,pulmonary endarterectomy,ECMO,pulmonary hemorrhage

Pulmoner Endarterektomi Sonrası Oluşan Masif Pulmoner Kanamanın Yönetimi

Abstract

Pulmoner endarterektomi (PEA) operasyonu sonrası gelişen perioperatif reperfüzyon hasarı, akut sağ kalp yetmezliği ve masif pulmoner hemoraji gibi komplikasyonlar mortalite ve morbiditeyi belirleyen en önemli faktörlerdir. Bu olguda pulmoner endarterektomi operasyonunda intraoperatif masif pulmoner hemoraji gelişen hastada tedavi yönetimimiz tartışıldı. 2017 yılında yapılan pulmoner hemoraji gelişen PEA operasyonu geriye dönük olarak incelendi. Bu olguda masif kanamayı durdurmak için endobronşiyal bloker kullanıldı. Hemodinamik ve respiratuvar gereksinimden dolayı da ekstrakorporeal membran oksijenizasyonu (ECMO) kullanıldı. ECMO kullanımı, PEA operasyonlarında per ve postoperatif gelişen birçok komplikasyon için alternatif bir yaklaşımdır. Bizim olgumuzda olduğu gibi endobronşiyal bloker ve Ecmo'nun birlikte kullanımı PEA sonrası gelişen masif pulmoner hemorajide etkin ve kullanışlı bir yaklaşım olabilir.

Keywords

• Pulmoner endarterektomi,PEA,PTE,ECMO,pulmoner hemoraji

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