Massive pulmonary embolism – attempt at embolectomy following the failure of thrombolytic treatment

Czech version

Authors: M. Třetina ¹; E. Petrikovits ²; B. Slaná ³; P. Rotterová ³; J. Černý ²; M. Kala ¹; M. Orban ⁴
Authors‘ workplace: Interní oddělení Nemocnice Boskovice, prim. MUDr. Milan Kala ¹; Centrum kardiovaskulární a transplantační chirurgie Brno, ředitel prof. MUDr. Jan Černý, CSc. ²; Patologicko-anatomický ústav Lékařské fakulty MU a FN u sv. Anny, Brno, přednosta prof. MUDr. Aleš Rejthar, CSc. ³; I. interní kardio-angiologická klinika Lékařské fakulty MU a FN u sv. Anny, Brno, přednosta prof. MUDr. Jiří Vítovec, CSc., FESC ⁴
Published in: Vnitř Lék 2006; 52(11): 1093-1096
Category: Case Reports

Overview

We report a case of a 61-year old woman with progressive dyspnoea, fatigue and tiredness over the last two weeks. Based on physical examination on admission, ECHO and CT exams, a diagnosis of massive pulmonary embolism was confirmed and the patient received thrombolytic treatment. Since no response to thrombolysis was apparent and the patient was clinically unstable with persisting signs of right ventricular dysfunction in echocardiography, a rescue surgical embolectomy was ordered and performed using cardiopulmonary bypass. Multiple large clots were removed from both pulmonary arteries. Following embolectomy, severe irreversible right ventricular failure developed and the patient died. Autopsy revealed large blood clots in peripheral pulmonary circulation causing terminal right-heart failure. We discuss the therapeutic options in massive pulmonary embolism and the potential role of rescue surgical embolectomy.

Sources

1. Sadeghi A, Brevetti GR, Kim S et al. Acute massive pulmonary embolism: role of the cardiac surgeon. Tex Heart Inst J 2005; 32: 430–433.

2. Aklog L, Williams CS, Byrne JG et al. Acute pulmonary embolectomy: a contemporary approach. Circulation 2002; 105: 1416–1419.

3. Widimský J, Malý J et al. Akutní plicní embolie a žilní trombóza: patogeneze, diagnostika, léčba a prevence. Praha: Triton 2005: 65–68.

4. Silverstein MD, Heit JA, Mohr DN et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population based-study. Arch Intern Med 1998; 158: 585–593.

5. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999; 353: 1386–1389.

6. Stulz P, Schlapfer R, Feer R et al. Decision making in the surgical treatment of massive pulmonary embolism. Eur J Cardiothorac Surg 1994; 8: 188–193.

7. Meysman M, Haentjens P. Pulmonary embolism: current treatment options. Curr Treat Options Cardiovasc Med 2005; 7: 483–490.

8. Ullmann M, Hemmer W, Hannekum A. The urgent pulmonary embolectomy: mechanical resuscitation in the operating theatre determines the outcome. Thorac Cardiovasc Surg 1999; 47: 5–8.

9. Riedel M. Acute pulmonary embolism. 2: treatment. Heart 2001; 85: 351–360.