State of the Art Management of Acute Pulmonary Embolism

Abstract

The desire for surgical intervention for pulmonary embolism (PE) precipitated the development of cardiopulmonary bypass, and therefore a new era in history of cardiac surgery, cardiology, and medicine. However, the advent of systemic thrombolysis and catheter-directed therapy have decreased interest in surgical management of PE. Surgical pulmonary embolectomy is limited to patients in critical condition with high mortality after other interventions have failed. The issue with clinicians delaying surgical pulmonary embolectomy is that in the interim patients may become critically ill with irreversible end organ dysfunction. Management necessitates decompression of RV afterload by relieving PE obstruction to improve RV function and left ventricular filling. Understanding the pathophysiology of right ventricular outflow tract (RVOT) obstruction and RV failure with a multidisciplinary heart team is paramount.