J Korean Med Sci.  2014 May;29(5):735-738. 10.3346/jkms.2014.29.5.735.

Thrombolytic Therapy Complemented by ECMO: Successful Treatment for A Case of Massive Pulmonary Thromboembolism with Hemodynamic Collapse

• Chon MK
• Park YH
• Choi JH
• Lee SH
• Kim JS
• Kim J
• Kim JH
• Chun KJ

• KMID: 1786118
• DOI: http://doi.org/10.3346/jkms.2014.29.5.735

Abstract

Pulmonary thromboembolism (PTE) is a common clinical condition related to significant mortality. Furthermore, patients with PTE presenting with right heart thrombus show higher mortality due to rapid hemodynamic deterioration. But the optimal treatment of massive PTE is controversial although various methods have been developed and improved. Here, we presented a case of 56-yr-old woman with massive PTE showing hemodynamic collapse, who was successfully treated with extracorporeal membrane oxygenation (ECMO) adjunct to thrombolytic therapy even without thrombectomy. ECMO was useful for resuscitation and stabilization of the cardiopulmonary function. In conclusion, thrombolytic therapy complemented by ECMO may be an effective treatment option for acute massive PTE with hemodynamic instability.

Keyword

Pulmonary Thromboembolism; Extracorporeal Membrane Oxygenation, Percutaneous Cardiopulmonary Support; Thrombolysis

MeSH Terms

*Extracorporeal Membrane Oxygenation
Female
Heart/physiopathology
Heparin/therapeutic use
Humans
Middle Aged
Myocardium/pathology
Pulmonary Artery/*physiopathology
Pulmonary Embolism/*therapy
*Thrombolytic Therapy
Tissue Plasminogen Activator/therapeutic use
Venous Thrombosis/*physiopathology
Warfarin/therapeutic use
Heparin
Tissue Plasminogen Activator
Warfarin

Figure

• 

  Fig. 1 Initial transthoracic echocardiography (TTE) image. (A) D-shape of LV on parasternal short axis view. (B) Free-floating, whip-like right atrial (RA) mass (arrow) suggesting thrombus. RA, right atrium; LV, left ventricle; LA, left atrium; Ao, aorta.

• 

  Fig. 2 Initial computed tomography (CT) image.Large saddle thrombus in main pulmonary artery and deep vein thrombus of external iliac vein (arrow) were presented in CT with contrast enhancement.

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  Fig. 3 Follow up computed tomography (CT) image, 1 month after discharge. Pulmonary thrombus in main pulmonary artery and deep vein thrombus of external iliac vein were clearly disappeared.

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