Central extracorporeal membrane oxygenation for treatment of reperfusion oedema following pulmonary thromboendarterectom
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CASE REPORT
Open Access
Central extracorporeal membrane oxygenation for treatment of reperfusion oedema following pulmonary thromboendarterectomy: a case report Alexander Edemskiy*, Mikhail Chernyavskiy, Alexandra Tarkova and Alexander Chernyavskiy
Abstract One of the most severe and frequent complication of pulmonary thromboendarterectomy is reperfusion pulmonary oedema. The only effective treatment for this complication is extracorporeal membrane oxygenation. A case of successful treatment of reperfusion pulmonary oedema with prolonged veno-arterial extracorporeal membrane oxygenation complicated by several episodes of bleeding and surgical site infection is presented. Keywords: Сhronic thromboembolic pulmonary hypertension, Pulmonary thromboendarterectomy, Lung reperfusion injury, Extracorporeal membrane oxygenation
Background Pulmonary thromboendarterectomy (PTE) is currently the gold standard treatment for chronic thromboembolic pulmonary hypertension (CTEPH) [1]. Intraoperative pulmonary haemorrhage, lung reperfusion oedema and the consequent development of right heart failure in the early postoperative period are the most severe and often fatal complications of this procedure. Often, the only option for treatment of these serious complications is the use of extracorporeal membrane oxygenation (ECMO) during the perioperative period [2, 3]. We present a clinical case of the successful use of ECMO after PTE. Case presentation A 31-year-old woman was hospitalised with a diagnosis of CTEPH, relapsing pulmonary thromboembolism and New York Heart Association functional class III heart failure. She had noted in 2013 the appearance of dyspnea that first occurred during light exercise and subsequently progressed. In August 2013, she was diagnosed with relapsing pulmonary thromboembolism. Echocardiography revealed a high pulmonary artery (PA) pressure of * Correspondence: [email protected] Department of Aorta and Coronary Arteries Surgery, Novosibirsk Research Institute of Circulation Pathology n.a. Academician E.N. Meshalkin, 15 Rechkunovskaya street, Novosibirsk 630055, Russia
54 mm Hg, dilated right heart chambers, and seconddegree tricuspid insufficiency; multi-spectral computed tomography (CT) revealed signs of thrombosis in the segmental branches of both PAs. However, the patient was not referred to a specialty surgical centre for assessment of her operability but was instead prescribed warfarin as an anticoagulant treatment. After a short period of stabilisation of her condition, the patient was hospitalised at her local healthcare facility for angiopulmonography and right heart catheterisation; her PA pressure was 110/34/59 mmHg, and chronic massive emboli of both branches of the PA were confirmed. The specialists at the referral centre reviewed her medical data and recommended PTE. The patient complained of dyspnoea after walking 100 m at her usual speed or while climbing one flight of stairs. The result of a 6-min walk test was 175 m. Echocardiography revealed dilated right heart chambers; a 20 % fract
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