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- Title
Tromboembolia pulmonar masiva, trombo en tránsito y disfunción ventricular derecha.
- Authors
Martínez, Luis Efrén Santos; Villarroel, Juan Eddy Uriona; Rodríguez, José Emilio Exaire; Mendoza, David; Guerra, María Luisa Martínez; Pulido, Tomás; Bautista, Edgar; Castañón, Alicia; Sandoval, Julio
- Abstract
Massive pulmonary embolism is associated with an increased mortality. It is secondary to migration of a venous thrombus to the right atrium or ventricle (thrombus in transit) towards the pulmonary circulation. The hemodynamic performance depends on the baseline cardiopulmonary status of the patient and the extent of obstruction. Right ventricular dysfunction will appear as a direct consequence of a major obstruction and hemodynamic collapse. The treatment of choice is thrombolysis, either intravenous in a peripheral vein, or local administration associated with percutaneous thrombus fragmentation or surgical embolectomy. We present the clinic case of a woman with massive pulmonary embolism. The transthoracic echocardiogram showed the presence of three auricular thrombus, right ventricular dysfunction and pulmonary hypertension. A right side catheterization and angiography demonstrated the pulmonary artery obstruction and right ventricular dysfunction. The troponin-I was elevated as a result of right ventricular strain. Mechanical thrombectomy was made using a pigtail catheter and thrombolysis into the pulmonary artery using recombinant tisular plasminogen activator. There was an immediate hemodynamic improvement and the post-thrombolysis angiography performed after 24-h demonstrated an improvement of the pulmonary circulation as well as decreased pulmonary artery pressures. (Arch Cardiol Mex 2007; 77: 44-53)
- Subjects
PULMONARY embolism; RIGHT heart ventricle; THROMBOEMBOLISM; THROMBOLYTIC therapy; EMBOLISMS
- Publication
Archivos de Cardiología de México, 2007, Vol 77, Issue 1, p44
- ISSN
1405-9940
- Publication type
Article