[HSF] Pulmonary embolism-RV dysfunction

[yadav del]

An year back the particular plastic surgery unit lost a patient from bleeding at surgical site[Abdominoplasty and liposuction] after thrombolysis for PE.May be  it would have made them not to take lightly the risk of bleeding  from thrombolysis in the immediate post op period
   
  I think hard data is lacking even for thrombolysys for ry dysfunction criteria alone for advantage in terms of mortality. one of the studies showed no difference in 2 month mortality with or with out thrombolysis  for this category of patients.
  One of the studies showed benefit in terms of end point of combined mortality and need for escalation  of therapy[like adding inotropes].
   
  Regional throbolysis  over few hours often leads to systemic lytic state  with same risks of bleeding. 
  We advised filter for this patient and plastic surgeons followed the advise of internists who felt they would advise it only in the circumstance of further progress in thrombosis inspite of anticoagulation.
  She had  relative resistance to heparin [ptt 45 at 2200 units per hr heparin infusion and it responded to FFP.

prasannasimha <prasannasimha at gmail.com> wrote:
  Catheter based mechanical lysis with a pigtail followed by thrombolysis 
can be done. If not then consideration for surgical embolectomy could be 
thought of. We have done quite a few catheter based lysis which gives a 
dramatic reduction in PA pressure and recovery of RV function.
Prasanna

yadav del wrote:
> 
> 
> 25 yrs old female developed pulmonary embolism on 2 nd post op day after repair of incisional hernia. CT scan showed emboli at both hila .Only left lower lobe artery is spared from emboli. Duplex scan showed bilateral ilio- femoral dvt. She iss haemodynamically stable. Saturation 94% with out oxygen and 98% on 2litres oxygen. Echo showed RV dysfunction. 
> 
> Should she be offered pulmonary embolectomy in view of RV dysfunction ?
>
> 
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