Pulmonary embolectomy in a child.
ABSTRACT We report the case of a 14-year-old boy treated successfully by pulmonary embolectomy for massive pulmonary embolism, 18 days after bilateral hip surgery. He has a family history of pulmonary embolism and an inherited antithrombin deficiency. His diagnosis was confirmed by spiral computed tomography scan. We believe that pulmonary embolectomy has a role in selected cases in children.
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ABSTRACT: During cardiac surgery it is sometimes necessary to examine heart chambers remote from the site of surgery. Similarly visualization of the pulmonary arterial tree will enable assessment for the completeness of pulmonary embolectomy. There are no standard adjunctive procedures to accomplish this. Left ventriculotomy used to examine the left ventricle, and maneuvers used to ensure complete pulmonary embolectomy can have serious complications. Impelled by the need to obviate the complications, we adopted and, herein describe a simple method of examining the cardiopulmonary system with an endoscope. Our early experience is also presented. Transmitral cardioscopy was performed in two patients, and pulmonary angioscopy in one. One patient had the combined procedure. The indications for transmitral cardioscopy were; suspected left ventricular thrombus and a right atrial thrombus propagating into the left atrium through a patent foramen ovale. The indications for pulmonary angioscopy were pulmonary embolectomy and right atrial thrombus. SSURGICAL TECHNIQUE Cardiopulmonary endoscopy was performed on cardiopulmonary bypass, at an appropriate stage of the primary procedure. For transmitral cardioscopy, a flexible fibreoptic endoscope was passed into the left ventricle through the right superior pulmonary vein, or the right atrium. For pulmonary endoscopy, the flexible endoscope was introduced through a pulmonary arteriotomy. At the end of the procedure, the port of entry of the endoscope was closed and cardiopulmonary bypass terminated. A good visualization of the cardiac chambers and the pulmonary artery was obtained in all the patients. One patient was found to have an endocardial scarring, and a left ventricular thrombus was excluded in another. Visual guidance facilitated pulmonary emboli retrieval. There were no complications in these patients. Cardiopulmonary endoscopy is simple, safe and effective in examining the cardiac chambers and the pulmonary arterial system. It can be performed with a sterilized flexible fibreoptic endoscope. It facilitates pulmonary embolectomy, and precludes procedures and maneuvers that can cause serious complications. It adds a visual advantage to pulmonary embolectomy, which is otherwise blind. Cardiopulmonary endoscopy has the potential for a wider applicability, possibly in minimally invasive and robotic cardiac surgery.European Journal of Cardio-Thoracic Surgery 03/2001; 19(2):152-5. · 2.67 Impact Factor
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ABSTRACT: Massive pulmonary embolism (PE) in a small child is a rare event and unified guidelines for its treatment are missing. Timely diagnosis and management of massive pulmonary embolism is of crucial importance for a good outcome. We describe a unique management of PE causing oxygenation failure using a combination of catheter extraction technique, and regional thrombolysis on top of systemic heparin administration and inferior vena cava filter placement. Pulmonary hypertension was treated with inhaled nitric oxide. We believe that catheter extraction technique and regional thrombolysis is an option to consider provided that resources and expertise are available. Preoperative placement of an inferior vena cava filter should be contemplated in such high risk situations.International Medical Case Reports Journal 01/2009; 2:1-5.