Abstract
A 59-year-old woman presented with a sudden onset of breathlessness and chest pain. An echocardiography and CT scan showed pulmonary embolism and infarction with a paradoxical thrombus visualised in both atria. For haemodynamically stable patients, the optimal management strategy is poorly defined. Three main strategies were considered: surgical thrombectomy, thrombolysis and anticoagulation. Surgery with reversal of anticoagulation may lead to further coagulation and increased risk of bleeding complications. The significant pulmonary hypertension and right ventricular infarction raised the prospect of difficult weaning from cardiopulmonary bypass following thrombectomy. Thrombolysis, which has significant mortality rate, and systemic embolisation including pulmonary infarction with haemorrhagic transformation were also contraindications. A multidisciplinary approach was adopted and anticoagulation was therefore believed to be the safest and effective approach. Here, the use of anticoagulation alone was fortunately successful but could as easily end in disaster. This approach should be considered the ideal paradigm to yield optimum outcomes.
References
Apr 1, 1985·Journal of the American College of Cardiology·U NellessenP R Lichtlen
Aug 15, 1995·The American Journal of Cardiology·C ZerioG L Nicolosi
Sep 1, 1994·European Heart Journal·M HargreavesS Westaby
Dec 1, 1994·American Heart Journal·L DaleyN G Pandian
Jul 1, 1964·British Heart Journal·B CORRIN
Oct 16, 2004·Heart·C Seiler
Oct 27, 2004·Rheumatology·V M Martinez-TaboadaJ A Armijo
Jan 25, 2005·European Journal of Echocardiography : the Journal of the Working Group on Echocardiography of the European Society of Cardiology·Franco CasazzaOrnella Agostoni
May 4, 2005·The Journal of Thoracic and Cardiovascular Surgery·Marzia LeaccheJohn G Byrne
Jun 28, 2008·Annales de cardiologie et d'angéiologie·R F BonviniM Righini
Oct 31, 2009·Journal of Vascular and Interventional Radiology : JVIR·William T KuoLawrence V Hofmann
Nov 26, 2010·The Annals of Thoracic Surgery·Hunaid A VohraSunil K Ohri
Mar 23, 2012·Revista Española De Cardiología·Igor F Palacios, Dabit Arzamendi
Mar 2, 2013·Seminars in Interventional Radiology·Nael Saad
Nov 27, 2014·Journal of Radiology Case Reports·Yasmin S HamiraniCarlos A Roldan
Dec 24, 2014·The American Journal of Medicine·Seoyoung C KimSebastian Schneeweiss
Dec 17, 2015·Echocardiography·Anuj MedirattaRoberto M Lang
Mar 6, 2016·Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography·Leah WrightThomas H Marwick
Jan 27, 2017·Cardiovascular Diagnosis and Therapy·Mehrzad ZarghouniAmy R Deipolyi