Yousry el-Moazamy
PSCC, Saudi Arabia
Title: Proactive surgical intervention for acute massive pulmonary embolism
Biography
Biography: Yousry el-Moazamy
Abstract
Massive pulmonary embolism (PE) is life-threatening complication in hospitalized patients. Optimal management of massive PE remains controversial. Despite advances in thermbolytic therapy major bleeding was reported in many series. Urgent surgical embolectomy has been the treatment of choice in patients with hemodynamic instability. We believe that patients with more or less stable hemodynamic, aggressive surgical intervention have beneficial with good outcome and still superior to medical treatment. Patients: 19 hospitalized patients suffered massive PE. Diagnoses were as follow: Post partum (n: 6), post RTA (n: 5), acute abdomen (n: 2), diagnosed intra-op (n: 2), failure of thrombolytic therapy (n: 2), one preop and one transferred from another hospital as acute on top of chronic PE. TEE confirmed the presence of huge clots in the heart and intra-pericardial pulmonary arteries. All patients were underwent surgical removal of the clots. Mean bypass time was 123.83 min, clamp time 57.50 min. five patients suffered of low cardiac output required vasopressor and dopamine early postoperative. The mortality was one patient transferred from another hospital with acute on top of chronic massive PE and one preop patient waiting open heart surgery. Conclusion: Early aggressive surgical intervention for even hemodynamically stable patients may constitute an important form for treatment of in hospital massive pulmonary embolism with good outcome. - TEE is the best tool to confirm the presence of associated intra-cardiac and intra-pulmonary thrombi helping the surgeon to locate embolus site.