Acute Crit Care.  2019 May;34(2):158-164. 10.4266/acc.2016.01032.

Central extracorporeal membrane oxygenation and early rehabilitation for persistent severe pulmonary hypertension following pulmonary endarterectomy

• Seong GM
• Hong SB
• Huh JW
• Lim CM
• Koh Y
• Lee JW
• Jung SH
• Park DW
• Lee JS

• KMID: 2449371
• DOI: http://doi.org/10.4266/acc.2016.01032

Abstract

Chronic thromboembolic pulmonary hypertension is potentially curable with a pulmonary endarterectomy. However, approximately 20% of patients have persistent pulmonary hypertension after pulmonary endarterectomy, which is a major risk factor for postoperative death. Here, we report a 34-year-old woman who suffered persistent severe pulmonary hypertension following a successful pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. Extracorporeal membrane oxygenation (ECMO) and atrial septostomy were successfully performed as rescue treatments, and active rehabilitation during ECMO was prescribed to facilitate recovery.

Keyword

endarterectomy; extracorporeal membrane oxygenation; pulmonary hypertension; rehabilitation

MeSH Terms

Adult
Endarterectomy*
Extracorporeal Membrane Oxygenation*
Female
Humans
Hypertension, Pulmonary*
Rehabilitation*
Risk Factors

Figure

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  Figure 1. Preoperative chest radiograph shows enlargement of the main pulmonary artery and of the right and left pulmonary arteries with peripheral pruning. The heart is enlarged with a prominent right atrial contour.

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  Figure 2. (A) Axial contrast-enhanced chest computed tomography confirms enlargement of the main pulmonary artery (6.5 cm) and shows wall-adherent chronic thrombus with calcification in the right pulmonary artery. The image shows the dilated right atrium (10.0 cm) and right ventricular hypertrophy. (B) Lung ventilation/perfusion scan reveals multiple mismatched perfusion defects in both lobes. MAA: macro aggregated albumin; ANT: anterior; LAO: left anterior oblique; LPO: left posterior oblique; POST: posterior; RPO: right posterior oblique; RAO: right anterior oblique.

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  Figure 3. Specimens removed from the pulmonary arteries during pulmonary endarterectomy.

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  Figure 4. Postoperative pulmonary angiography reveals total occlusion (arrows) of the right (A) and left (B) basal trunks of the pulmonary artery.

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  Figure 5. Chest radiograph obtained after central-type conversion shows the drainage cannula in the right atrium (white arrow) and the return cannula in the ascending aorta (black arrows).

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