| Autor: |
Moldovan H; Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 014461 Bucharest, Romania.; Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania., Sibisan AM; Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania., Tiganasu R; Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania., Nechifor E; SANADOR Clinical Hospital, 010991 Bucharest, Romania., Gheorghita D; Faculty of Materials Science and Engineering, Politehnica University of Bucharest, 060042 Bucharest, Romania., Zaharia O; Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 014461 Bucharest, Romania.; Prof. Dr. Theodor Burghele Clinical Hospital, 050659 Bucharest, Romania., Albu M; Clinical Hospital Ploiesti, 100337 Ploiesti, Romania., Popescu D; SANADOR Clinical Hospital, 010991 Bucharest, Romania., Molnar A; Iuliu Hateganu University of Medicine and Pharmacy, 400012 Cluj Napoca, Romania.; Heart Institute, 400001 Cluj Napoca, Romania., Craciun M; SANADOR Clinical Hospital, 010991 Bucharest, Romania., Scafa A; Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 014461 Bucharest, Romania.; Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania. |
| Abstrakt: |
We present the case of a 35-year-old woman who had a high-risk pulmonary embolism (according to ESC risk stratification for pulmonary embolism) after she had undergone a Caesarion section. Postoperatively, she presented with acute left lower limb pain, swelling and erythema. A diagnosis was made of deep vein thrombosis (DVT) of the ilio-femoral and popliteal veins. She was started on anticoagulant therapy, which proved to be inefficient, the patient developing a left calf and thigh oedema and shortness of breath. A CT scan revealed high-risk embolus located in the right atrium and through the tricuspid valve. The decision was made to refer her to a cardiovascular surgeon. During her preoperative evaluation, the patient became hemodynamically unstable and was rushed into the operating room, severely desaturated, bradycardic, without consciousness, with severe hypotension. On the basis of the severe state of the patient and the CT scan findings we performed an emergency pulmonary embolectomy, with the patient on cardio-pulmonary by-pass, without cross-clamping the aorta, using a modified Trendelenburg procedure. This case supports using open pulmonary embolectomy for patients with hemodynamic instability on the basis of clinical diagnosis. |
