A Case of Pulmonary Embolism which Recovered by Emergency Surgical Embolectomy

Abstract

The mainstay of pulmonary embolism (PE) treatment is anticoagulation. If a patient with acute PE fails to respond to initial anticoagulation, with worsening cardiovascular instability and respiratory failure, then, surgical embolectomy should be considered. We present the PE case of a 39-year-old woman who was overweight and had oral contraceptives for a few months. The patient was hospitalized for a diagnosis of PE and started to receive anticoagulant therapy with heparin. But two days after, the patient suffered from worsening of PE. Though the patient's cardiovascular stability was maintained with percutaneous cardiopulmonary support (PCPS) and intra aortic balloon pumping (IABP), the pulmonary thrombus was enlarged under the CT image. Also, right ventricle dysfunction was detected by echocardiography. And then, the patient undertook emergency surgical embolectomy. After the surgery, the patient needed PCPS support for two days for the right ventricle dysfunction. The patient was discharged from the intensive care unit without PCPS and IABP, four days after the surgery. The patient left the hospital on foot, 22 days after the surgery.
We experienced a case of sub-massive PE during the anticoagulant therapy. The patient was successfully saved by emergency surgical embolectomy.