RESUMEN
Missile embolism to the pulmonary artery is a rare event. We present a complicated case of missile embolism from the inferior vena cava to the pulmonary artery. The case illustrates the potential pitfalls in the management of these patients.
Asunto(s)
Arteria Pulmonar/patología , Embolia Pulmonar/etiología , Embolia Pulmonar/cirugía , Vena Cava Inferior/patología , Heridas por Arma de Fuego/complicaciones , Adulto , Angiografía/métodos , Estudios de Seguimiento , Humanos , Masculino , Traumatismo Múltiple/diagnóstico , Traumatismo Múltiple/cirugía , Neumonectomía/métodos , Arteria Pulmonar/diagnóstico por imagen , Embolia Pulmonar/diagnóstico por imagen , Radiografía Torácica , Medición de Riesgo , Toracotomía/métodos , Resultado del Tratamiento , Vena Cava Inferior/diagnóstico por imagenRESUMEN
BACKGROUND: The ascending aorta is the customary site for arterial cannulation for cardiopulmonary bypass. Favorable experience at our institution and elsewhere using axillary artery cannulation in treating type A aortic dissections has caused us to broaden our indications for using this site for arterial cannulation for cardiopulmonary bypass. METHODS: Medical records, operative notes, and perfusion records were reviewed in all patients in whom the axillary artery was cannulated directly or by a graft for cardiopulmonary bypass from January 1, 2000 through August 30, 2002. RESULTS: Seventy-five patients underwent axillary artery cannulation during the 32-month interval. Eleven patients had ascending aortic dissections, 20 had extensively diseased ascending aortas, and 44 were individuals undergoing repeat cardiac procedures. The right axillary artery was used in 72 patients and the left in 3. In 16 patients the artery was cannulated directly, and in 59 the arterial cannula was inserted into a prosthetic graft that had been anastomosed to the axillary artery. Axillary artery cannulation was satisfactory in 95% (71 of 75) of the cases in which it was used. CONCLUSIONS: Cannulation of the axillary artery for cardiopulmonary bypass is a dependable approach for procedures including reoperations, aortic dissections, and extensively diseased ascending aortas.