Highly Complicated operation of pulmonary thromboendarterectomy along with removal of huge blood clot from right side of heart carried out in patient at NSSH

In a highly complicated operation which could have resulted into death, stroke, liver or kidney failure along with other multiple complications a chronic thrombus (blood clot) was surgically extricated from the heart and lungs and lungs of ChandrakantGholum (56) at Nanavati Super Speciality Hospital (NSSH)

"When the patient was bought in at NSSH he acutely breathless even whilst in sitting position on 5lt of oxygen per minute. He gave a confirmed h/o past pulmonary embolism to left artery following an orthopaedic procedure at another hospital 3 year ago. We immediately suspected acute on chronic pulmonary embolism and admitted him to the ICCU a trans-thoracic echo of the heart showed huge mobile thrombus in right atrium going across the tricuspid valve into the right ventricle.

His systemic and pulmonary artery pressures were identical. A CT scan showed clot occluding the major parts of the left and right pulmonary arteries s well as its lobar branches. following pre-operational investigations, we placed him on bi-caval bypass opened his right heart and extricated a foot long thrombus which extended from his inferior vena cava to his right atrium and the superior vena cava." stated Dr. Hemant Pathare, Cardio-Vascular, Heart and lung transplant surgeon.

The Patient's body was then cooled to 18 degrees Celsius and the heart and lung pump was stopped, technically indicating that there was no blood flow in the body or brain. The right pulmonary artery was incised and the old thrombus was removed along with the part of the pulmonary arterial inner wall. Then the artery was thoroughly lavage and closed. The heart and lung machine was restarted at 18 °C for around 20min. the machine was stopped again and the same procedure was repeated in the left pulmonary artery.

The patient was gradually rewarmed in about 4hrs to 37°C. He came off the HL machine on inotropic support, pacemaker and intra-aortic balloon pump to help the sick right & left ventricles.

4 days later he took his first few steps in the ICCU. His pulmonary artery pressure is now 1/3 of the pressure in the aorta. A filter has been put in the inferior vena cava of the patient to prevent recurrence of the same. A pulmonary angiography of the patient has indicated full clearance.

The Complicated nature of the surgery can be gauged from the fact that there were high chances of the patient developing permanent neurological complications or bleeding diathesis

Due to complicated nature of the surgery. The period when the body is cooled to around 18degree Celsius is a crucial phase and one has to be very quick at that temperature to prevent permanent brain damage.