Pulmonary artery

Question 1

Massive PE treatment

Answer 1

“Simple” pulmonary embolectomy can be done with cardiopulmonary bypass using a single venous cannula, mindful of air; without cardioplegic arrest (unless Secundum ASD) but with aortic vent.

Rarely associated with reperfusion injury to lung

Consider IVC filter placement at time of surgery

Question 2

Embolus in transit.

Answer 2

Abundant right atrial clot, seen on CT. Must evaluate the reason for this.

1. abnormal intra-atrial fibrous bands or web around IVC junction (“Eustachian valve”)
2. coronary sinus (“Thebesian valve”)
3. secundum atrial septal defect (ASD)
4. large patent foramen ovale (PFO)