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Case Reports
. 2024 Jan:114:109159.
doi: 10.1016/j.ijscr.2023.109159. Epub 2023 Dec 15.

Successful surgical management of large pulmonary artery thrombosis in a patient with primary severe mitral regurgitation and complex congenital heart disease: A case report

Phan Quang Thuan  1 , Pham Tran Viet Chuong  1 , Ho Duc Thang  1 , Dinh Long Nhiem  1 , Nguyen Hoai Nam  2 , Nguyen Hoang Dinh  3
Affiliations
Case Reports

Successful surgical management of large pulmonary artery thrombosis in a patient with primary severe mitral regurgitation and complex congenital heart disease: A case report

Phan Quang Thuan et al. Int J Surg Case Rep. 2024 Jan.

Abstract

Introduction: Pulmonary artery thrombosis presents a rare and formidable challenge, especially in individuals with untreated complex congenital heart diseases and concurrent valvular abnormalities.

Presentation of case: This case details a distinctive instance of pulmonary artery thrombosis in a patient with untreated congenital atrial septal defect, severe pulmonary hypertension, pulmonary aneurysm, valvular heart disease, and triple-positive antiphospholipid antibodies. Collaborative decision-making by a heart team guided the diagnostic and therapeutic processes, resulting in surgical interventions encompassing pulmonary thrombectomy, mitral and tricuspid regurgitation repair, and atrial septal defect closure.

Discussion: The case underscores the nuanced management of pulmonary artery thrombosis within the realm of congenital heart disease, highlighting the imperative role of a multidisciplinary approach in achieving accurate diagnoses and timely interventions. The multifaceted treatment strategy implemented further accentuates the need for continual monitoring and personalized interventions in intricate clinical scenarios.

Conclusion: In conclusion, this case emphasizes the complexity of addressing pulmonary artery thrombosis in the context of congenital heart disease. The collaborative efforts of a multidisciplinary team proved pivotal in navigating diagnostic uncertainties and formulating a tailored treatment plan. Ongoing monitoring and personalized strategies remain crucial for optimizing outcomes in such intricate cases.

Keywords: Antiphospholipid antibodies; Atrial septal defect; Congenital heart disease; Heart team; Pulmonary artery aneurysm; Pulmonary artery thrombosis; Pulmonary hypertension; Valvular heart disease.

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Conflict of interest statement

Conflict of interest statement The author(s) declare no conflict of interest in preparing this article.

Figures

Fig. 1
Fig. 1
ECG displaying S1Q3T3 pattern with right bundle branch block (arrow).
Fig. 2
Fig. 2
A: shows an X-ray of the patient before surgery, B shows an X-ray taken 6 days after surgery, with enlargement of the two hilars and consolidation of the right lung (arrow). C shows an X-ray of a patient two months after surgery with enlarged two hilum (arrow).
Fig. 3
Fig. 3
A: Preoperative CT showed an enlarged pulmonary artery of the trunk and two main branches, nearly occlusion thrombosis of the left main pulmonary artery, and thrombus of the right main pulmonary artery (arrow). B: CT of the patient two months after surgery showed that the pulmonary aneurysm has reduced in size, and there is little wall thrombus in the left main pulmonary artery (arrow). C shows a preoperative CT with ASD (arrow). D: Postoperative CT with patched ASD (arrow), and mitral annulus, tricuspid annulus (star).
Fig. 4
Fig. 4
A: shows an aneurysm of the trunk pulmonary artery (arrow). B: shows thrombosis of the left main pulmonary artery (arrow). C: shows thrombosis of the right main pulmonary artery (arrow). D: shows a large ASD (arrow). E: displays an image of thrombus after removal from the pulmonary artery. F: shows pathology with organized thrombosis and vascular wall.
See this image and copyright information in PMC

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