Tromboembolia pulmonar masiva, trombo en tránsito y disfunción ventricular derecha / Massive pulmonary embolism, thrombus in transit, and right ventricular dysfunction
Arch. cardiol. Méx
; 77(1): 44-53, ene.-mar. 2007. ilus
Article
em Es
| LILACS
| ID: lil-566907
Biblioteca responsável:
BR1.1
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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
LILACS
Assunto principal:
Embolia Pulmonar
/
Trombose
/
Trombectomia
/
Disfunção Ventricular Direita
/
Átrios do Coração
/
Cardiopatias
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
Idioma:
Es
Revista:
Arch. cardiol. Méx
Assunto da revista:
CARDIOLOGIA
Ano de publicação:
2007
Tipo de documento:
Article
País de afiliação:
México
País de publicação:
México