Acute Massive Pulmonary Embolism in a Jehovah's Witness(*)

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Date: Feb. 2000
From: Chest(Vol. 117, Issue 2)
Publisher: Elsevier B.V.
Document Type: Article
Length: 1,511 words

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Successful Treatment With Catheter Thrombectomy

A 71-year-old woman presented with an acute, massive pulmonary embolism. As a Jehovah's Witness, she was not willing to accept thrombolysis because of the potential risk of bleeding requiring blood transfusion. The patient was successfully treated with catheter thrombectomy, using rheolytic and fragmentation devices.

(CHEST 2000; 117:594-597)

Key words: catheter thrombectomy; Jehovah's Witness; pulmonary embolism; thrombolysis

Abbreviation: PE = pulmonary embolism

Acute massive pulmonary embolism (PE) accounts for approximately 50,000 deaths per year in the United States.[1] The options for treatment of massive PE, in addition to the standard treatment of anticoagulation with heparin, include the following: thrombolytic therapy, open surgical embolectomy, and catheter thrombectomy.[2] Intracranial hemorrhage after thrombolysis for PE is an infrequent but grave complication.[3] In addition to specific contraindications to thrombolytic therapy, a patient may be unwilling to accept the potential risk of bleeding that would require the transfusion of blood products. With recent technologic advances in thrombectomy devices, catheter thrombectomy may be an option. We report a Jehovah's Witness patient with an acute massive PE who was successfully treated with catheter thrombectomy.

CASE REPORT

The patient is a 71-year-old African-American woman with a history of poorly controlled arterial hypertension. She presented with the acute onset of shortness of breath at rest, worsening over 4 days. There was no cough, hemoptysis, fever, or chest pain. She denied any history of smoking, cancer, or immobilization.

On admission, her BP was 130/108 mm Hg, pulse rate was 148 beats/min, and respiration rate was 26 breaths/min. The examination was significant for a right ventricular S3 gallop, and left basilar rales. The chest radiograph showed a small left pleural effusion and oligemia of the right upper lung field. An arterial blood gas analysis, drawn while breathing room air, showed pH 7.46, Pa[CO.sub.2] of 27 mm Hg, and Pa[O.sub.2] of 50 mm Hg. ECG revealed sinus tachycardia, left ventricular hypertrophy, and lateral ST-segment depression. An emergency transthoracic echocardiogram in the emergency department was technically limited, and showed normal left ventricular function and normal right ventricular size. The patient was started on IV heparin for suspected PE. The oxygen saturation was 95% while breathing 100% oxygen. A ventilation/perfusion scan (Fig 1) showed absent perfusion of the right lung with normal ventilation, consistent with a high...

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Gale Document Number: GALE|A60099702