Massive pulmonary thromboembolism and catheter-directed thrombotic fragmentation in anticoagulated post-surgical patient. A cascade of events.

Main Article Content

Eduardo Fernando Barrio Nuñez
Juan Pablo Masías
Juan Carlos Medina

Abstract

Introduction: Massive pulmonary thromboembolism (PTE) is characterized by sustained arterial hypotension, cardiogenic shock, or both and presents a high in-hospital mortality. Treatment, in addition to hemodynamic and respiratory support measures, includes anticoagulation and systemic fibrinolysis. Between a third and half of patients have a contraindication to thrombolysis, mainly due to recent major surgery, and in approximately 8% of cases, it is unsuccessful. A surgical embolectomy or percutaneous treatment can be performed in selected centers in these situations.


Clinical case: 58-year-old male patient with arterial hypertension, undergoing Bentall de Bono surgery for severe aortic insufficiency. In the immediate postoperative period, he presented with hemodynamic instability associated with atrial fibrillation and signs of cardiac tamponade. Despite multiple interventions, including electrical cardioversion and pericardiocentesis, the patient developed cardiogenic shock and massive pulmonary thromboembolism, requiring mechanical ventilation and vasopressor support.


Conclusions: Percutaneous catheter-directed treatment as a reperfusion option should be considered for patients with high-risk PE where thrombolysis is contraindicated. The diagnostic strategy for suspected PE ensures timely treatment and improves the survival of these patients. A multidisciplinary team and implementing a program to treat high-risk PE are necessary.

Downloads

Download data is not yet available.

Article Details

How to Cite
Massive pulmonary thromboembolism and catheter-directed thrombotic fragmentation in anticoagulated post-surgical patient.: A cascade of events. (2024). Actas Médicas (Ecuador), 34(Suplement 1), S-8. https://doi.org/10.61284/195
Section
Case Reports

How to Cite

Massive pulmonary thromboembolism and catheter-directed thrombotic fragmentation in anticoagulated post-surgical patient.: A cascade of events. (2024). Actas Médicas (Ecuador), 34(Suplement 1), S-8. https://doi.org/10.61284/195

Most read articles by the same author(s)