Pulmonary thromboendarterectomy

Chronic thromboembolic pulmonary hypertension is an preventable and treatable disease. Pulmonary thromboendothelioma is an effective method for the treatment of chronic pulmonary embolism. Treatment of diseases: pulmonary embolism and pulmonary infarction pulmonary embolism Indication Chronic pulmonary embolism. Contraindications 1, with systemic diseases, can not tolerate surgery. 2, local infection, not suitable for surgery. Preoperative preparation Antibiotics are routinely used before surgery. Surgical procedure Under general anesthesia, the median sternal incision was made, and the extracorporeal circulation was routinely established. Two drainage tubes were placed in the pulmonary artery and the left atrium. The left and right pulmonary arteries were resected in the parallel circulation cooling process, and the pulmonary artery and its branches were fully exposed. The main pulmonary artery was dissected. Remove large pieces of blood clots. Block the ascending aorta, infused with 1000ml cold stop fluid, the surface of the myocardium was cooled with iced saline and ice debris, cut the right atrium, and the tricuspid valve was explored to clear the right intraventricular thorium. When the nasal temperature dropped to 19 °C The circulation was stopped, the right pulmonary artery was dissected, and the mechanical thrombus was removed from the vascular lumen from the proximal and distal end. The left pulmonary artery was removed in the same way. After the thrombus was cleared, the circulation was resumed. complication Right heart failure Long-term damage to the right heart function before surgery, due to insufficient intraoperative myocardial protection, postoperative pulmonary vascular bed reperfusion after reactive vasoconstriction and pulmonary artery pressure failed to decline rapidly, leading to postoperative right heart failure the reason. Therefore, the myocardial is fully protected during surgery, postoperative hemodynamic monitoring, and timely measures are taken. Commonly used drugs for lowering pulmonary arterial pressure have the effect of reducing peripheral arterial pressure. Selective pulmonary hypertension, nitric oxide, has been used in recent years. It is safe, effective and easy to control by inhaling 20-10 ppm of nitric oxide with special equipment. 2. Reperfusion of pulmonary edema Also known as "local ARDS", "pulmonary hemorrhagic syndrome", manifested as postoperative obvious hypoxemia, can occur immediately after surgery or after 3 to 5 days, the incidence rate is about 20%, mechanical ventilation is necessary Supplemented with PEEP, it can be gradually recovered after a few days. At the end of the operation, corticosteroids should be administered intravenously. The next day, it can be reduced by one time. In severe cases, there may be a large amount of intrabronchial hemorrhage. The side airway can be blocked by Carlen catheter to temporarily fill the blood clotting. And stop. 3. bilateral phrenic palsy Due to intraoperative anatomical pull, ischemia, local hypothermia and other factors, respiratory support should be restored. 4. Prevention of re-formation and recurrence of thromboembolism Anticoagulant therapy should be given after surgery, the specific method is the same as after acute pulmonary embolism.