Circulatory support with venovenous ECMO in a patient with reperfusion pulmonary edema after pulmonary artery thromboendarterectomy

Emmanuel A. Lazcano-Díaz, Servicio de Terapia Intensiva Cardiovascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Uriel Encarnación-Martínez, Servicio de Terapia Intensiva Cardiovascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Cristhian J. Gaytán-García, Servicio de Terapia Intensiva Cardiovascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Daniel Manzur-Sandoval, Servicio de Terapia Intensiva Cardiovascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Francisco J. González-Ruiz, Servicio de Terapia Intensiva Cardiovascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Edgar García-Cruz, Servicio de Terapia Intensiva Cardiovascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Ángel Ramos-Enríquez, Servicio de Terapia Intensiva Cardiovascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Luis E. Santos-Martínez, Servicio de Terapia Intensiva Cardiovascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Luis A. Cota-Apodaca, Servicio de Terapia Intensiva Cardiovascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Benjamín I. Hernández-Mejía, Servicio de Terapia Intensiva Cardiovascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Dania E. Escamilla-Ríos, Servicio de Terapia Intensiva Cardiovascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Gustavo Rojas-Velasco, Servicio de Terapia Intensiva Cardiovascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México

Chronic thromboembolic pulmonary hypertension (CTEPH) is a subtype of pulmonary hypertension characterized by the obstruction of pulmonary arteries secondary to chronic thromboembolism. Pulmonary thromboendarterectomy surgery (PTE) is the main treatment for patients with CTEPH, as it removes the chronic thrombi from the pulmonary arteries. Pulmonary reperfusion syndrome is a common complication of the surgery, which involves the development of pulmonary edema in the area where blood perfusion improves after the surgery. The incidence of this syndrome varies from 8 to 91% depending on the criteria used for diagnosis, and it is one of the most serious complications of pulmonary thromboendarterectomy. In such cases, circulatory support with extracorporeal membrane oxygenation (ECMO) has become a valuable therapeutic modality. We present the case of a 60-year-old woman with a history of acute pulmonary embolism due to deep vein thrombosis of the right pelvic limb who was diagnosed later with CTEPH who was admitted for scheduled surgical treatment involving bilateral PTE. However, during the immediate postoperative period, she developed cardiogenic shock and refractory hypoxemia secondary to pulmonary reperfusion syndrome following the surgical procedure. As a result, she required veno-venous ECMO circulatory support for 6 days, leading to resolution of the pulmonary condition and clinical improvement.

Keywords: Chronic thromboembolic pulmonary hypertension. Reperfusion pulmonary edema. Veno-venous ECMO.