Valencia-Sánchez JS, Ramírez-Arias E, Ortega-Romo E

Language: Spanish
References: 24
Page: 418-423
PDF size: 903.51 Kb.

ABSTRACT

Background: Pulmonary embolism is a potentially fatal heart condition that requires prompt restoration of blood flow in the pulmonary vascular bed and prevention of recurrent events. Mortality is associated to the degree of hemodynamic repercussion, complications and opportunity in the treatment.
Case report: Male 33 years of age who began with sudden dyspnea, chest pain of moderate intensity, sweating and syncope. His admission vitals signs: blood pressure 100/70 mm Hg, heart rate 125 beats per minute, respiratory rate 24; peripheral saturation 85 %. Physical examination: grade I jugular engorgement at 45 degrees, rhythmic heart sounds, with auscultation of systolic murmur I/IV in tricuspid focus and second reinforced heart sound. Rest of exploration without relevant data. The echocardiogram showed data of right ventricular failure and systolic pulmonary artery pressure of 60 mm Hg; the angiotomography showed thrombosis of both branches of the pulmonary artery. The patient received fibrinolytic therapy with tecneteplase 50 mg single bolus and antithrombotic therapy. Due to persistence of residual thrombus, the patient underwent surgical bilateral embolectomy.
Conclusion: Surgical pulmonary embolectomy rescue is an alternative management with highly satisfactory results.

REFERENCES

1. Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galié N, Pruszczyk P, et al. Guías de Práctica Clínica de la Sociedad Europea de Cardiología sobre diagnóstico y manejo del tromboembolismo pulmonar agudo. Rev Esp Cardiol. 2008;61(12):1330.e1-1330.e52. Disponible en: http://secardiologia.es/images/stories/documentos/guiatep. pdf

2. Bĕlohlávek J, Dytrych V, Linhart A. Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism. Exp Clin Cardiol. 2013;18 (2):129-138.

3. Roy PM, Meyer G, Vielle B, Le Gall C, Verschuren F, Carentier F, et al. Appropriateness of diagnostic management and outcomes of suspected pulmonary embolism. Ann Intern Med. 2006;144:157-64.

4. White RH. The epidemiology of venous thromboembolism. Circulation. 2003;107(Suppl 1):I4-I8.

5. Stein PD, Kayali F, Olson RE. Estimated case fatality rate of pulmonary embolism, 1979 to 1998. Am J Cardiol. 2004; 93:1197-1199.

6. Dalen JE, Alpert JS. Natural history of pulmonary embolism. Prog Cardiovasc Dis. 1975;17:259-70.

7. Nieto JA, Ruiz-Ribó MD. Tromboembolismo pulmonar. Luces y sombras. Rev Esp Cardiol. 2008;61:229-32.

8. Goldhaber SZ, Visani L, De Rosa M. Acute Pulmonary embolism: clinical outcomes in the International Cooperative pulmonary Embolism Registry (ICOPER). Lancet. 1999;353(9162):1386-89.

9. McIntyre KM, Sasahara AA. The hemodynamic response to pulmonary embolism in patients without prior cardiopulmonary disease. Am J Cardiol. 1971;28:288-94.

10. Bonow RO, Mann DL, Zipes DP, Libby P, Braunwald E. Tratado de Cardiología. 9th ed. Madrid, España: Elsevier España, SL; 2013. pp. 1702-1718.

11. Cabrera-Rayo A, Nellen-Hummel H. Epidemiología de la enfermedad tromboembólica venosa. Gac Méd Méx. 2007; 143(Supl. 1):3-5.

12. Martínez-Sánchez CR, Gonzalez-Pacheco H, Martinez- Reding JO. Urgencias cardiovasculares. 3a Ed. México. D.F.: Editorial Intersistemas; 2013. pp. 209-218.

13. Feigenbaum H, Armstrong WF, Ryan T. Ecocardiografia. 6th ed. Philadelphia, USA: Lippincott Williams & Wilkins; 2012. pp. 203-211.

14. Haddad F, Hunt SA, Rosenthal DN, Murphy DJ. Right Ventricular Function in Cardiovascular. Disease, Part I. 2 Anatomy, Physiology, Aging, and Functional Assessment of the Right Ventricle. Circulation. 2008;117:1436-1448.

15. Haddad F, Doyle R, Murphy DJ, Hunt SA. Right Ventricular Function in Cardiovascular Disease. Part II. Pathophysiology, Clinical Importance, and Management of Right Ventricular Failure. Circulation. 2008;117:1717-1731.

16. Meyer G, Vicaut E, Danays T, Agnelli G, Becattini C, Beyer-Westendork J, et al. Fibrinolysis for patients with Intermediate Risk Pulmonary Embolism. N Engl J Med. 2014;370:1402-1411.

17. Nakamura S, Takano H, Kubota Y, Asai K, Shimizu W. Impact of the efficacy of thrombolytic therapy on the mortality of patients with acute submassive pulmonary embolism: a meta-analysis. J Thromb Haemost. 2014;12: 1086-1095.

18. Goldhaver SZ. Surgical Pulmonary Embolectomy. The resurrection an Almost Discarded Operation. Tex Heart I J. 2013;40(1):5-8.

19. Jaber WA, Fong PP, Weisz G, Lattouf O, Jenkins J, Rosenfield K, et al. Acute Pulmonary Embolism: With an Emphasis on an Interventional Approach. J Am Coll Cardiol. 2016;67:991-1002.

20. Stein PD, Matta F. Case fatality rate with pulmonary embolectomy for acute pulmonary embolism. Am J Med. 2012;125:471-477.

21. Cho YH, Sung K, Kim WS, Jeong DS, Lee YT, Park PW, et al. Management of acute massive pulmonary embolism: Is surgical embolectomy inferior to thrombolysis? Int J Cardiol. 2016;203:579-83.

22. Azari A, Bigdelu L, Moravvej Z. Surgical embolectomy in the management of massive and sub-massive pulmonary embolism: The results of 30 consecutive ill patients. ARYA Atheroscler. 2015;11:208-13.

23. Meneveau N, Séronde MF, Blonde MC, Legalery P, Petit KD, Briand F, et al. Management of Unsuccessful Thrombolysis in Acute Massive Pulmonary Embolism. Chest. 2006;129:1043-1050.

24. Bĕlohlávek J, Dytrych V, Limhart A. Pulmonary embolism, Part II: management. Exp Clin Cardiol. 2013;18(2):139- 147.