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Atrial trans-septal thrombus in massive pulmonary embolism salvaged by prolonged extracorporeal life support after thrombo-embolectomy. A bridge to right-sided cardiovascular adaptation.
MedLine Citation:
PMID:  23215749     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Massive pulmonary embolism poses a therapeutic challenge, especially when thrombolytics are controversial. We describe the complicated course of an exceptional case of massive pulmonary embolism exhibiting paradoxic embolization with a thrombus lodged in the foramen ovale. Thrombolysis was considered contraindicated and surgical intervention was performed. Postoperatively, persistent pulmonary hypertension and impending right ventricular (RV) failure necessitated the initiation of extracorporeal life support (ELS), accompanied by therapeutic heparinization, inhaled nitric oxide, levosimendan and sildenafil. On day 8, the patient was successfully weaned from ELS with excellent neurological recovery and virtual normalization of RV pressures and dimensions. (Contra-) indications for thrombolysis and surgical embolectomy are reviewed. The intriguing role of ELS in conjunction with therapeutic heparinization and pharmacological unloading of the right-sided vasculature and the RV is discussed.
Authors:
Thijs S R Delnoij; Ryan E Accord; Patrick W Weerwind; Dirk W Donker
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Acute cardiac care     Volume:  14     ISSN:  1748-295X     ISO Abbreviation:  Acute Card Care     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101276603     Medline TA:  Acute Card Care     Country:  England    
Other Details:
Languages:  eng     Pagination:  138-40     Citation Subset:  IM    
Affiliation:
Department of Intensive Care.
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