Author + information
- Chung-Ho Hsu1
Patient initials or identifier number
Relevant clinical history and physical exam
A 12 year-old girl with a history of Klippel-Trennaunay syndrome (K-T syndrome) admitted to our plasty surgery ward for lymph reconstruction of left lower limb. After general anesthesia, sudden collapse noted and CPCR was performed for 30 minutes.
Relevant test results prior to catheterization
TEE showed dilated RV and PA without flow to PA trunk and ECMO was set. CT showed bilateral pulmonary embolism.
Relevant catheterization findings
Angiography showed thrombus over right upper pulmonary artery and left upper/middle and lower pulmonary artery. RV 44/11 mmHg, LPA 48/20 mmHg. RV 44/ddd 11 mmHg, LPA 48/20 mmHg.
Two 6Fr sheaths were inserted to right common femoral vein. Right upper lobe PA was selected and tPA 5 mg was injected via homemade side-holes JR4 guiding catheter. A 18 cm infusion length EKOS was set. Left lower PA was selected and another 18 cm EKOS was set for thrombolysis. Overnight thrombolysis with tPA was performed. Followed up angiography showed patent R upper PA/L upper and middle PA with residual thrombus over left lower PA. Left lower PA was selected and thrombectomy with Proton V4 was performed. IVUS and PTA with POBA was performed. Final pressure RPA 29/15 mmHg, LPA 16/13 mmHg. Followed up, CT showed complete resolution of thrombus and ECMO and ventilator was weaned successfully.
For patient with life threatening massive pulmonary embolism with unstable vital signs, pharmacomechanical thrombectomy (PMT) with EKOS under ECMO support can be en effective and safe treatment modality.