Post Surgical Pulmonary Embolectomy and Veno Venous Extra Corporeal Membrane Oxygenerator support - Right Ventricular Recovery.
Kawryshanker S. Rajaratnam, Kaushalendra Singh Rathore.
Sir Charles Gairdner Hospital, Nedlands, Australia.
OBJECTIVE: Saddle Pulmonary Embolism causes sudden and Severe RVOT obstruction leads to transient Severe Acute Right Heart Failure SARHFWhich is most likely reversible and needs mechanical support VVECMO to decompress the right ventricle for a reasonably short period of time to recover the right ventricular function and good outcome.
METHODS:7 patients underwent emergency surgical Pulmonary Embolectomy under Cardio Pulmonary Bypass CPB, Not able to wean off due to SARHF. Despite of large doses of variable inotrophoes. But weaned off and RVrecovery with ECMO incredibly
RESULTS: : Wedo surgical pulmonary embolectomy for haemodynamically unstable, Severe RV strain and contraindication for Thrombolysis patients with saddle and massive obstructive PE. We operated 50patients, among 7 of them had SARHF. We managed with ECMO to recover RV, All of themshown quick recovery of RV function, removal of ECMO was possible. 2 patients palliated due to brain death, they underwent long down time CPRpreoperatively
CONCLUSIONS: SARHF very high mortality. Certain extent moderate RV dysfunction can be managed with high dosages of Dobutamine, Milrinone, Nitric Oxide, Iloprost. If no response in order to wean off CPB and RV recovery particularly severedysfunction, the Only choice is VVECMO. Acute RV strain and stretch due to clot burden induce mechanical RVOT obstruction followed by acute catecholamine surge- predisposes SARHF .They induced changes in Myocardial composition and disarrangements of cytoskeletal, contractile proteins and extracellular matrix. Decompression of RV with good perfusion via the coronaries decrease the myocardial demand aid functional and structural recovery of RV myocardium make the SARHF reversible.
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