Acute right ventricular failure caused by concomitant coronary and pulmonary embolism: successful treatment with endovascular coronary and pulmonary thrombectomy

Abstract

IntroductionRespiratory distress and hypoxia in the acute phase of ST-segment elevation myocardial infarction (STEMI) is generally seen in large anterior infarctions resulting in acute heart failure and pulmonary oedema or with acute mechanical complications, including rupture of the ventricular septum, papillary muscle, or free ventricular wall. 1 However, angiographic evidence of occlusion only in smaller coronary branches in conjunction with echocardiography without signs of mechanical complication should lead the clinician to consider concomitant complicating disease. We describe a case of inferolateral STEMI, presenting with chest pain, severe dyspnoea, and hypoxia, related to extensive pulmonary embolism. Case reportA 69-year-old woman presented with sudden onset of severe retrosternal chest pain. She had a history of hypertension and treatment with 5 mg felodipine daily, but had never smoked and was otherwise healthy. An electrocardiogram recorded in the ambulance showed significant ST-segment elevations in inferior (II, aVF, III) AbstractPatent 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.

Imaging in non Traumatic Emergencies: Acute Thrombosis of the Aorta and Pulmonary Embolism

“…Pulmonary embolism is a known complication of cardiac operations, and other major operations, but we found no descriptions of its coexistence with acute arterial thrombosis, except in the presence of patent foramen ovale [1], thrombi in the right cardiac ventricle and other arteriovenous connections [2] - the so--called "paradoxical embolism", which may be arterial (cerebrovascular stroke, coronary stroke) or venous (pulmonary embolism) 1--2 .…”

“…When it does occur [1][2][3][4] , according to the reports reviewed, the presentation tends to be dramatic, and management must be quick and involve various modalities of imaging and intensive medical and surgical treatment (anticoagulation and surgical/endovascular interventions) [1][2][3][4] . Pulmonary embolism is a known complication of cardiac operations, and other major operations, but we found no descriptions of its coexistence with acute arterial thrombosis, except in the presence of patent foramen ovale [1], thrombi in the right cardiac ventricle and other arteriovenous connections [2] - the so--called "paradoxical embolism", which may be arterial (cerebrovascular stroke, coronary stroke) or venous (pulmonary embolism) 1--2 .…”

Leriche syndrome in a patient with acute pulmonary embolism and acute myocardial infarction: a case report and review of literature

“…Another important aspect of our case is the incidental finding of aortoiliac occlusive disease, so-called Leriche syndrome. First mentioned by Irish anatomist Jones Quain in 1847 and later described by French surgeon Rene Leriche in 1940, Leriche syndrome is a rare variant of atherosclerothrombotic occlusive disease characterized by total occlusion of the abdominal aorta and both iliac arteries [7,18]. Except for typical exacerbating factors such as hypertension, diabetes mellitus, hyperlipidemia, and smoking, other etiologies including developmental defect of aortic growth, radiation exposure, congenital rubella infection, luetic aortitis, Takayasu arteritis, and retroperitoneal fibrosis have also been postulated [19].…”

Zatorowość paradoksalna ośrodkowego układu nerwowego u pacjenta z ostrą zatorowością płucną wysokiego ryzyka

“…Pacjenta przekazano na oddział O istniejącym drożnym otworze owalnym (PFO, patent foramen ovale) u pacjentów z zatorowością płucną (PE, pulmonary embolism) najczęściej dowiadujemy się, oglądając mrożące krew w żyłach obrazy skrzeplin "w podróży", które zatrzymywały się w jamach prawego serca. Skrzepliny takie często wklinowują się w PFO, przechodzą do lewego przedsionka i powodują objawy zatorowości systemowej [1,2]. Mimo braku dowodów z badań klinicznych, większość ekspertów zaleca w takiej sytuacji leczenie kardiochirurgiczne, obawiając się fragmentacji skrzeplin w lewym sercu po zastosowaniu trombolizy [3].…”