title: [Massive pulmonary embolism, thrombus in transit, and right ventricular dysfunction].
abstract: Massive pulmonary embolism is associated with an increased mortality. It is secondary to migration of a venous thrombus to the right atrium or ventricle (thrombus in transit) towards the pulmonary circulation. The hemodynamic performance depends on the baseline cardiopulmonary status of the patient and the extent of obstruction. Right ventricular dysfunction will appear as a direct consequence of a major obstruction and hemodynamic collapse. The treatment of choice is thrombolysis, either intravenous in a peripheral vein, or local administration associated with percutaneous thrombus fragmentation or surgical embolectomy. We present the clinic case of a woman with massive pulmonary embolism. The transthoracic echocardiogram showed the presence of three auricular thrombus, right ventricular dysfunction and pulmonary hypertension. A right side catheterization and angiography demonstrated the pulmonary artery obstruction and right ventricular dysfunction. The troponin-I was elevated as a result of right ventricular strain. Mechanical thrombectomy was made using a pigtail catheter and thrombolysis into the pulmonary artery using recombinant tisular plasminogen activator. There was an immediate hemodynamic improvement and the post-thrombolysis angiography performed after 24-h demonstrated an improvement of the pulmonary circulation as well as decreased pulmonary artery pressures.
authors.affiliation: Departamento de Cardioneumologí,. Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano Núm. 1. Col. Sección XVI, Tlalpan 14080, DF México. sanlui@cardiologia.org.mx
authors.forename: Luis Efrén
authors.initials: LE
authors.lastname: Santos Martínez
authors.forename: Juan Eddy
authors.initials: JE
authors.lastname: Uriona Villarroel
authors.forename: José Emilio
authors.initials: JE
authors.lastname: Exaire Rodríguez
authors.forename: David
authors.initials: D
authors.lastname: Mendoza
authors.forename: María Luisa
authors.initials: ML
authors.lastname: Martínez Guerra
authors.forename: Tomás
authors.initials: T
authors.lastname: Pulido
authors.forename: Edgar
authors.initials: E
authors.lastname: Bautista
authors.forename: Alicia
authors.initials: A
authors.lastname: Castañón
authors.forename: Julio
authors.initials: J
authors.lastname: Sandoval
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000792:Angiography; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D006328:Cardiac Catheterization; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging; D006331:Heart Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D017131:Thrombectomy; D013927:Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000209:etiology*; D014859:Warfarin / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D014859:Warfarin; D010959:Tissue Plasminogen Activator