Elie M. Elmann

Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism.

Background Extracorporeal Membrane Oxygenation (ECMO) has been suggested for cardiopulmonary support in patients with massive pulmonary embolism (PE) refractory to other treatment or as bridging to embolectomy. The survival benefit from ECMO in patients with massive PE remains unclear. Methods Here, we describe 5 cases in which ECMO was used as cardiopulmonary support following massive near‐fatal pulmonary embolism. Results The overall mortality in patients with massive PE that received ECMO support was 40%. Death occurred secondary to ECMO‐related complication in one case and due to inability to maintain adequate cerebral perfusion despite ECMO support in the second case. Conclusions ECMO can be considered as a treatment modality for patients with massive PE.

Benign Metastasizing Leiomyomatosis of the Lungs Presenting a Miliary Pattern

Benign metastasizing leiomyomatosis is a very rare and significantly interesting pathology of the lungs. It is a challenge to clinicians when presenting a miliary pattern in preoperative radiologic imaging because it could be any other interstitial disease or infectious in etiology such as miliary tuberculosis. We report a case of innumerable tiny nodular densities spread evenly throughout both lungs in a patient with history of hysterectomy for a fibroid uterus.

Extracorporeal membrane oxygenation in transcatheter aortic valve replacement.

Background Patients undergoing transcatheter aortic valve replacement can experience severe perioperative complications leading to hemodynamic instability and death. Venoarterial extracorporeal membrane oxygenation can be used to provide cardiorespiratory support during this time. Methods From 2012 to 2015, of 247 patients who underwent transcatheter aortic valve replacement, 6 (2.42%) required extracorporeal membrane oxygenation support. Their mean age was 82 ± 7.4 years, mean Society of Thoracic Surgeons score was 9.4 ± 6.6, and mean aortic gradient was 28.3 ± 12 mm Hg. Rescue extracorporeal membrane oxygenation was required for hemodynamic instability due to ventricular fibrillation (n = 1), respiratory failure (n = 1), left ventricular wall rupture (n = 2), and aortic annulus rupture (n = 1). In one patient, prophylactic extracorporeal membrane oxygenation was required due to advanced heart failure. Additional procedures included valve-in-valve implantation (n = 1), conversion to an open procedure (n = 3), and intraaortic balloon pump insertion (n = 1). Results The median hospital stay was 20 days. There were 2 hospital deaths in patients whose hospital course was complicated by left ventricular wall rupture or aortic annulus rupture with resulting tamponade. Among the 4 survivors, one required continuous ventilator support following discharge, and 3 experienced no major complications during the first month after discharge. Conclusions Extracorporeal membrane oxygenation can be considered a viable option for high-risk patients undergoing transcatheter aortic valve replacement and those who develop cardiac complications following this procedure and require cardiorespiratory support.

Extracorporeal Membrane Oxygenation Support After Ivor-Lewis Esophagectomy for Esophageal Adenocarcinoma

Respiratory failure after Ivor-Lewis esophagectomy results in poor outcomes. Limited treatment strategies are available to manage this severe complication. One possibility is extracorporeal support. We report the successful use of extracorporeal support as a successful strategy for refractory respiratory failure.

Cocaine Related Myocardial Infarction and Ventricular Rupture

Cardiovascular complications following cocaine use are well described. We present a case of myocardial infarction and ventricular rupture in a young individual with limited underlying coronary disease and habitual cocaine use. The role of each is discussed.