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Background: The optimal use of pharmaco-mechanical therapy is not clear in the management of the acute massive pulmonary thromboembolism. Methods: A 30-year-old postpartum female presented with acute massive pulmonary embolism and was managed with catheter mediated thrombus aspiration and fragmentation after the standard intravenous thrombolysis had failed. Thrombus was aspirated by 7F Mullins sheath with 50cc aspiration syringe and was fragmented by TYSHAK II PTV balloon. This was followed by catheter directed thrombolysis. Results: Intravenous thrombolysis was only partially successful whereas catheter mediated thrombus aspiration and fragmentation followed by catheter directed thrombolysis resulted in hemodynamic stabilization and early discharge from the hospital. Conclusion: Pharmaco-mechanical therapy is an effective therapy of acute massive pulmonary embolism and may be beneficial over the standard systemic thrombolysis.

Background: The anatomical variability in patients with anomalous pulmonary venous connection to superior vena cava presents a surgical challenge. The problem is further compounded by the common occurrence of postoperative complications like arrhythmias and obstruction of the superior vena cava or pulmonary veins. We present our experience of managing this subset using the two patch and Warden's techniques. Patients and methods: Between June 2011 and September 2012, 7 patients with APVC to the SVC were operated in our institute. After delineating the anatomy, five of them had a two patch repair and two were managed with Warden's technique. Results: There was no in-hospital mortality or early mortality over a mean follow-up of 9.66 ± 3.88 months (range 6–15 months). All the patients on follow-up had unobstructed pulmonary venous and SVC drainage on echocardiography and all of them were in normal sinus rhythm. Conclusions: Anomalous pulmonary venous connection to superior vena cava is a challenging subset of patients in whom the surgical management needs to be individualized. The detailed anatomy must be delineated using echocardiography with or without CT angiography before deciding the surgical plan. This entity can be repaired with excellent immediate and early results. However, these patients must be closely followed up for complications like systemic and pulmonary venous obstruction and sinus node dysfunction.