Surgical Treatment in a High-Risk Pulmonary Embolism: Case Report

被引:1
|
作者
Moldovan, Horatiu [1 ,2 ]
Sibisan, Andra-Madalina [2 ]
Tiganasu, Robert [2 ]
Nechifor, Elena [3 ]
Gheorghita, Daniela [4 ]
Zaharia, Ondin [1 ,5 ]
Albu, Mihai [6 ]
Popescu, Daniela [3 ]
Molnar, Adrian [7 ,8 ]
Craciun, Mihaela [3 ]
Scafa, Alexandru [1 ,2 ]
机构
[1] Carol Davila Univ Med & Pharm, Fac Med, Bucharest 014461, Romania
[2] Emergency Clin Hosp Bucharest, Bucharest 014461, Romania
[3] SANADOR Clin Hosp, Bucharest 010991, Romania
[4] Univ Politehn Bucuresti, Fac Mat Sci & Engn, Bucharest 060042, Romania
[5] Prof Dr Theodor Burghele Clin Hosp, Bucharest 050659, Romania
[6] Clin Hosp Ploiesti, Ploiesti 100337, Romania
[7] Iuliu Hateganu Univ Med & Pharm, Cluj Napoca 400012, Romania
[8] Heart Inst, Cluj Napoca 400001, Romania
来源
MEDICINA-LITHUANIA | 2021年 / 57卷 / 07期
关键词
major pulmonary embolism; emergency pulmonary embolectomy; modified trendelenburg procedure; AGGRESSIVE APPROACH; EMBOLECTOMY; ECHOCARDIOGRAPHY; MANAGEMENT; DIAGNOSIS;
D O I
10.3390/medicina57070725
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
We present the case of a 35-year-old woman who had a high-risk pulmonary embolism (according to ESC risk stratification for pulmonary embolism) after she had undergone a Caesarion section. Postoperatively, she presented with acute left lower limb pain, swelling and erythema. A diagnosis was made of deep vein thrombosis (DVT) of the ilio-femoral and popliteal veins. She was started on anticoagulant therapy, which proved to be inefficient, the patient developing a left calf and thigh oedema and shortness of breath. A CT scan revealed high-risk embolus located in the right atrium and through the tricuspid valve. The decision was made to refer her to a cardiovascular surgeon. During her preoperative evaluation, the patient became hemodynamically unstable and was rushed into the operating room, severely desaturated, bradycardic, without consciousness, with severe hypotension. On the basis of the severe state of the patient and the CT scan findings we performed an emergency pulmonary embolectomy, with the patient on cardio-pulmonary by-pass, without cross-clamping the aorta, using a modified Trendelenburg procedure. This case supports using open pulmonary embolectomy for patients with hemodynamic instability on the basis of clinical diagnosis.
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页数:6
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