Successful Lysis in Massive Pulmonary Embolism with Thrombus Entrapped in Pfo

• Published in: The American journal of cardiology Vol. 121; no. 8; p. e20
• Main Authors: Kucukseymen, Selcuk, Bayar, Nermin, Koklu, Erkan, Cagirci, Goksel, Yuksel, Isa, Arslan, Sakir
• Format: Journal Article
• Language: English
• Published: New York Elsevier Limited 15-04-2018
• Subjects: Angiography; Arteries; Blood clots; Bone surgery; Catheters; Computed tomography; Echocardiography; Embolism; Embolisms; Lysis; Pulmonary arteries; Pulmonary artery; Pulmonary embolisms; Therapy; Thrombosis; Veins & arteries
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2018.03.068

Before we come, contrast-enhanced computerized tomography angiography (CTA) for pulmonary arteries was performed, and bilaterally massive thrombus was seen on main pulmonary arteries (Figure 1), and she was hemodynamically unstable. [...]an urgent transthoracic echocardiography (TTE) was performed and showed an mobile thrombus in the right atrium, also revealed a patent foramen ovale (PFO) and systolic pulmonary artery pressure was 80 mm Hg. The risks and benefits of embolectomy were extensively discussed with patient, her family and surgerons. Because the patient's age made her a high-risk surgical candidate, cardiothoracic surgeons decided that she is inoperable for his surgical intervention, thus the dicision was made to proceed with thrombolytic therapy, and 25 mg of intraveous tissue plasminogen activator (TPA) was administered wtihin 12 hours as a slow infusion up to a total of 50 mg TPA. After termination of the last döşe of TPA, TEE was repeated, The intracardiac thrombus in the bilateral atrium were completely resolved (Figure 3), also CTA was repeated too, thrombus in main pulmonary arteries was disappeared in the left pulmonary artery totally, however not totally disappeared in the right side, even so it was smaller (Figure 3).