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Case Reports
. 2012 Jul-Aug;32(4):433-6.
doi: 10.5144/0256-4947.2012.433.

Life-saving percutaneous intervention in young patient with massive pulmonary embolism

Zul Hilmi Yaakob  1 , Abdul Wahab Undok, Imran Zainal Abidin, Wan Azman Wan Ahmad
Affiliations
Case Reports

Life-saving percutaneous intervention in young patient with massive pulmonary embolism

Zul Hilmi Yaakob et al. Ann Saudi Med. 2012 Jul-Aug.

Abstract

Massive pulmonary embolism (PE) is not an uncommon condition, and it usually carries a high risk of mortality. It is one of the fatal conditions that commonly affect young patients. A definitive treatment for patients with massive PE is still lacking, and surgical intervention carries a substantial mortality risk. Thus, percutaneous intervention (clot fragmentation and/or aspiration) remains an option in some patients, specifically in those with a risk of bleeding, contraindicating the use of thrombolysis. There have been no randomized trials to validate percutaneous intervention in massive PE. A sufficient level of evidence is still lacking, and its use depends upon the expert committee's opinion and study of previous case reports. We present a 23-year-old man with first onset massive PE secondary to protein C deficiency, who was treated successfully with the combination of systemic thrombolysis and percutaneous interventions.

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Figures

Figure 1
Figure 1
Electrocardiography of the patient in the case report showing sinus tachycardia, right bundle branch block and S1Q3T3 pattern.
Figure 2
Figure 2
Chest radiograph of the patient in the case report revealing a wedge-shaped opacity in the left lower lobe which is a finding of pulmonary infarction (Hampton hump) at the left lung.
Figure 3
Figure 3
CT pulmonary angiogram of the patient in the case report revealing a large thrombus in the right main pulmonary artery.
Figure 4
Figure 4
Pressure tracing of pulmonary artery with pressure recorded as 62/35 mm Hg.
Figure 5
Figure 5
Right pulmonary angiogram showing huge filling defect obliterating the distal main right pulmonary trunk.
Figure 6
Figure 6
Left pulmonary angiogram showing a filling defect in the lower left artery.
Figure 7
Figure 7
Balloon clot fragmentation done with OPTA PRO 7×14 mm (The balloon was inflated to compress and passed through the thrombus a several times).
Figure 8
Figure 8
Result after clot fragmentation with Balloon OPTA PRO 7×14 mm, showing a significant amount of thrombus, but much improved blood flow in the right pulmonary arterial system with relief in acute occlusion.
Figure 9
Figure 9
A repeat pulmonary angiogram showing small residual thrombus in the right pulmonary artery
See this image and copyright information in PMC

References

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