Management of intrapulmonary hemorrhage in patients undergoing pulmonary thrombo-endarterectomy

• Main Authors: Muralidhar Kanchi, Hema C Nair, Pooja Natarajan, Julius Punnen, Varun Shetty, Sanjay Orathi Patangi, Deviprasad Shetty, Kumar Belani
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2021-01-01
• Series: Annals of Cardiac Anaesthesia
• Subjects: chronic thromboembolic pulmonary hypertension; cteph; pulmonary hemorrhage; pulmonary thromboendarterectomy; pte
• Online Access: http://www.annals.in/article.asp?issn=0971-9784;year=2021;volume=24;issue=3;spage=384;epage=388;aulast=Kanchi

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.