Mobile Right Ventricle Thrombosis in Young Adult

ODÜ Tıp Dergisi/ODU Journal of Medicine (2015): e14-e16
ODÜ Tıp Dergisi / ODU Journal of Medicine
http://otd.odu.edu.tr
Olgu Sunumu
Case Report
Odu J Med
(2015) 1: 14-e16
Mobile Right Ventricle Thrombosis in Young Adult: AcutePulmonary Embolus Surgery
Genç Erişkinde Hareketli Sağ Ventrikül Trombüsü: Akut Pulmoner Emboli Cerrahisi
Deniz Demir1, Cumhur Murat Tulay2, Tuba Yiğit3
Şanlıurfa Mehmet Akif İnan Education and Research Hospital Departments of 1Cardiovascular
Surgery, 2Thoracic Surgery, and 3Anesthesiology, Şanlıurfa/ Türkiye
Yazının geliş tarihi / Received: 27 Ocak 2014 / Jan 27, 2014
Düzeltme / Revised: 15 Temmuz 2014 / July 15, 2014
Kabul tarihi / Accepted: 18 Temmuz 2014 / July 18, 2014
Abstract
Özet
Pulmonary embolism is a life-threatening clinical
condition. Although there are well-known risk
factors for pulmonary embolism, approximately
1/3 of cases occur without any predisposing factor.
Anticoagulation,
thrombolysis,
catheter
embolectomy and surgery are treatment
strategies. We wanted to explain a case who had
multiple mobile thrombotic masses which
extended from right atrium to the right ventricle.
Right atriotomy with cardiopulmonary bypass was
done to the patient and about 20-30 cc fresh
thrombus were taken from the right atrium.
Key Words: Pulmonary embolism, emergency
pulmonary embolectomy, ventricular thrombosis
Pulmoner emboli hayatı tehdit eden klinik bir
durumdur. Pulmoner emboli için iyi bilinen risk
faktörleri olmasına rağmen, vakaların yaklaşık
1/3’ünde altta yatan predispozan faktör
bulunmamaktadır. Antikoagulasyon, tromboliz,
katater
embolektomi
ve
cerrahi
tedavi
seçenekleridir. Biz burada sağ atriumdan sağ
ventriküle uzanım gösteren multiple hareketli
trombotik lezyonları olan vakamızı sunmak istedik.
Kardiyopulmoner bypass ile sağ atriotomi
uygulanarak yaklaşık 20-30 cc taze trombüs sağ
atriumdan çıkartıldı.
Anahtar Kelimeler: Pulmoner emboli, acil
pulmoner embolektomi, ventriküler tromboz
[Metni yazın]
Dr. Cumhur Murat Tulay, Şanlıurfa Mehmet Akif İnan Education and Research Hospital, Department of Thoracic Surgery,
Şanlıurfa / Türkiye
e-mail: cumhurtulay@hotmail.com, tel: +904143186635
Demir ve ark / Demir et al / ODÜ Tıp Dergisi/ODU Journal of Medicine (2015):e14-e16
Pleuritic chest pain and dyspnea are the most common
symptoms for pulmonary embolism. Deep veins
thrombosis of lower extremities is common cause of
pulmonary embolism (4). Deep vein thrombosis history
was seen in our case. While operative mortality rate of
acute massive pulmonary emboli was about 20-57% in
the past, it has been changed to 5.3-19% today.
Preoperative cardiopulmonary resuscitation, massive or
submassive emboli, hemodynamic stability of patient and
early surgery are important factors that affect mortality.
While mortality is observed 59% of preoperative CPR
performed patients, this ratio is decreased to 29% of
patient in non-performed ones (5).
Introduction
P
ulmonary embolism is a life-threatening condition
with prevalence about 0.4%. Although old age,
deep vein thrombosis, prolonged bed-rest,
hypercoagulability, malignancies are well-known risk
factors, 30% of cases occur without any predisposing
factor.(1) Acute major pulmonary embolism has high
mortality rates. While massive pulmonary embolism
results of shock condition, right ventricular dysfunction
results from submassive form without hemodynamic
instability. Anticoagulation with heparin, thrombolysis,
catheter
embolectomy
and
open
pulmonary
embolectomy are treatment strategies.(2) We wanted to
explain a case who had life-threatening multiple mobile
thrombotic masses detected by echocardiography which
extended from right atrium to right ventricle.
In our patient, mobile thrombus which was expanded
from right atrium to ventricle by echocardiography and
we decided to emergency operation due to lifethreatening condition. Mobile right heart ventricle
thrombosis is a rare condition and it generally causes
mortality (6). We think that early surgery for massive
pulmonary emboli with hemodynamic stability decreases
mortality rates.
Case Report
A 27 year-old male was admitted to emergency service
with respiratory distress and chest pain. Deep vein
thrombosis which was occurred 2 years ago and 6
months warfarin use were learned from his past medical
history. Multiple mobile thrombotic masses detected by
echocardiography which extended from right atrium to
right ventricle and mean pulmonary artery pressure was
52 mmHg. Hemodynamically stable patient was taken to
emergency
operation.
Right
atriotomy
with
cardiopulmonary bypass was done to patient and about
20-30 cc fresh thrombus were taken from right atrium.
Inferior vena cava was approximately occluded by
thrombus and it was removed. Pulmonary arteriotomy
was done. About 2x2 cm size thrombus was excised from
right and left pulmonary artery distinction.(Figure 1)
Repeating embolectomies were done by different
catheter sizes and too much embolus material were
removed from left and right pulmonary arteries. Opened
cardiac spaces were washed with heparin. Operation
was ended by no macroscopic embolus material. Clinical
and hemodynamic evaluations were normal at fourth
month after operation and mean pulmonary artery
pressure was measured 20-25 mmHg.
References
1. Jacek K, Jerzy G, , Maciej G,Anna C, Marek J. S. Multislice
Computed Tomography Angiography as an Imaging Modality
of Choice in Patients with Suspicion of Pulmonary Embolism–
Own Experiences and Modern Imaging Techniques Adv Clin
Exp Med 2013, 22, 5, 705–13.
2. Yalamanchili
K, Fleisher
AG, Lehrman
SG, Axelrod
HI, Lafaro RJ, Sarabu MR, Zias EA, Moggio RA.Open
pulmonary embolectomy for treatment of major pulmonary
embolism.Ann Thorac Surg. 2004;77(3):819.
3. Yekeler İ, Ateş A, Cerrahoğlu M, Koçak H, Becit N,
Karaoğlanoğlu N, Başoğlu A, Ateşal S. Akut Pulmoner
Embolide İnvaziv Girişim, Erken Embolektomi ve Proflaksi.
Türk Göğüs Kalp Damar Cerrahisi Dergisi. 1997, 5; 4:286-91.
4. Kadakal F, Çetinkaya E, Yıldız P, Soysal F, Tekin A, Yılmaz V.
Klinik Olarak Yüksek Olasılıklı Pulmoner Emboli Olgularında
Tanı. Solunum Hastalıkları 2000; 11: 140-3.
5. Taniguchi S, Fukuda W, Fukuda I, Watanabe K, Saito
Y, Nakamura
M, Sakuma
M.
Outcome
of pulmonary embolectomy
for acute pulmonary thromboembolism: analysis of 32 patients
from a multicentre registry in Japan.Interact Cardiovasc
Thorac Surg. 2012;14(1):64-7.
6. Kazuki H, Takafumi Y, Daisuke O. Surgical Embolectomy of
a Floating Right Heart. Thrombus and Acute Massive
Pulmonary Embolism: Report of a Case Ann Thorac
Cardiovasc Surg 2013; 19: 316–9.
Discussion
Pulmonary embolism is a serious pathology which was
defined in 1819. Mortality and morbidity are increased
by pulmonary embolism. The first successful surgical
operation with extracorporeal circulation was reported
by Sharp in 1962 (3).
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Demir ve ark / Demir et al / ODÜ Tıp Dergisi/ODU Journal of Medicine (2015):e14-e16
Figure 1: Intraoperative appearance of emboli
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