Acute right ventricular failure caused by concomitant coronary and pulmonary embolism: successful treatment with endovascular coronary and pulmonary thrombectomy.
Patent foramen ovale (PFO) is present in approximately 25% of the general population. PFO is characterized by intermittent shunting of blood from the right to the left atrium, especially in the context of increased right-sided filling pressures, with risk of paradoxical embolism. We describe a 69-year-old woman presenting with acute chest pain, severe dyspnoea, and acute inferolateral ST-segment elevation on the electrocardiogram. The patient was diagnosed with myocardial infarction and failure of the right cardiac ventricle, which was considered to be secondary to extensive pulmonary embolism leading to increased filling pressures and paradoxical coronary embolism. The patient underwent emergent percutaneous interventions with coronary thrombus extraction and pulmonary thrombus fragmentation and local thrombolysis. The patient was free of symptoms at follow up 6 months later and echocardiography showed substantially improved right ventricular function. We discuss issues related to the diagnosis, treatment, and secondary prevention for patients with concomitant pulmonary and coronary arterial thrombosis.
Lund University, Lund, Sweden ; Skåne University Hospital, Lund, Sweden.
J Gustav
JG
Smith
Sasha
S
Koul
Anders
A
Roijer
Jasminka
J
Holmqvist
Inger
I
Keussen
Wojciech
W
Cwikiel
Bertil
B
Ohlin
David
D
Erlinge
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D054059:Coronary Occlusion / Q000209:etiology / Q000628:therapy; D023921:Coronary Stenosis / Q000209:etiology / Q000628:therapy; D003331:Coronary Vessels; D004617:Embolism / Q000628:therapy*; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000628:therapy*; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology / Q000628:therapy; D011655:Pulmonary Embolism / Q000150:complications / Q000628:therapy; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000628:therapy*
Myocardial infarction; patent foramen ovale; percutaneous coronary intervention; pulmonary artery intervention; pulmonary embolism; right heart failure