What are the techniques of pumonary embolism operations ?
Technique of Operation : Patients who are very unstable will have to be put on bypass by cannulation of femoral artery and vein before anaesthesia and median sternotomy are done. Ascending aortic cannulation and separate cannulation of SVC and IVC are done and snares passed around these for total cardiopulmonary bypass. A left atrial vent catheter is passed through right superior pulmonary vein to decoinpress the heart. Aorta is clamped and cold blood cardioplegia given to the aortic root. The pulmonary trunk is incised vertically upto the bifurcation or if necessary into the left pulmonary artery. The emboli are removed and is necessary the right pulmonary artery is separately opened between retracted ascending aorta and superior vena cava. A sterile fibre optic bronchoscope can be used to enter secondary and tertiary branches to remove clots. Pleurae are widely opened and lungs squeezed to remove the remaining clots. Right atrium is opened and clots from atrium and ventricle removed. After closing right atrium and pulmonary artery, de-airing is done and aortic clamp is removed. Patient is weaned off by-pass and chest closed. Prophylactically, inferior vena caval filter is applied.