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June 1974

Massive Pulmonary Hemorrhagic Infarction: Following Revascularization of Ischemic Lungs

Author Affiliations

Los Angeles
From the Department of Surgery, US Naval Hospital, Long Beach, Calif (Dr. Brown) and the Division of Thoracic Surgery, UCLA Medical Center, Los Angeles (Drs. Mulder and Buckberg).

Arch Surg. 1974;108(6):795-797. doi:10.1001/archsurg.1974.01350300037010

While revascularization of acutely ischemic regions of the brain may result in hemorrhagic infarction, this is not a recognized hazard of pulmonary revascularization. Three patients recently entered the UCLA Medical Center with severe pulmonary ischemia (obstructed tricuspid valve prosthesis, obstructed atrial baffle following repair of transposition of the great vessels, massive pulmonary embolism) and died from massive tracheobronchial hemorrhage following successful surgical restoration of pulmonary blood flow. In each patient, severe pulmonary edema developed while left atrial pressure was below normal, indicating loss of lung capillary integrity. There was an inverse relationship between the duration of preexisting ischemia and the onset of rapidity of developing hemorrhagic infarction following restoration of normal pulmonary blood flow. This observation suggests that the lung capillary wall may be at least partially protected by collateral circulation when the ischemia develops slowly. Awareness of this potentially lethal complication may allow for earlier and more appropriate management.

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