Vnitr Lek 2006, 52(11):1093-1096

Massive pulmonary embolism - attempt at embolectomy following the failure of thrombolytic treatment

M. Třetina^1,*, E. Petrikovits², B. Slaná³, P. Rotterová³, J. Černý², M. Kala¹, M. Orban⁴

¹ Interní oddělení Nemocnice Boskovice, prim. MUDr. Milan Kala

² Centrum kardiovaskulární a transplantační chirurgie Brno, ředitel prof. MUDr. Jan Černý, CSc.

³ Patologicko-anatomický ústav Lékařské fakulty MU a FN u sv. Anny, Brno, přednosta prof. MUDr. Aleš Rejthar, CSc.

⁴ I. interní kardio-angiologická klinika Lékařské fakulty MU a FN u sv. Anny, Brno, přednosta prof. MUDr. Jiří Vítovec, CSc., FESC

We report a case of a 61-year old woman with progressive dyspnoea, fatigue and tiredness over the last two weeks. Based on physical examination on admission, ECHO and CT exams, a diagnosis of massive pulmonary embolism was confirmed and the patient received thrombolytic treatment. Since no response to thrombolysis was apparent and the patient was clinically unstable with persisting signs of right ventricular dysfunction in echocardiography, a rescue surgical embolectomy was ordered and performed using cardiopulmonary bypass. Multiple large clots were removed from both pulmonary arteries. Following embolectomy, severe irreversible right ventricular failure developed and the patient died. Autopsy revealed large blood clots in peripheral pulmonary circulation causing terminal right-heart failure. We discuss the therapeutic options in massive pulmonary embolism and the potential role of rescue surgical embolectomy.

Keywords: plicní embolie; trombolýza; embolektomie

Received: June 21, 2006; Accepted: August 11, 2006; Published: November 1, 2006  Show citation