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Bridging to a delayed pulmonary endarterectomy in massive acute-on-chronic pulmonary thromboembolism: a case report
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Bridging to a delayed pulmonary endarterectomy in massive acute-on-chronic pulmonary thromboembolism: a case report
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Journal Article
Bridging to a delayed pulmonary endarterectomy in massive acute-on-chronic pulmonary thromboembolism: a case report
2025
Overview
Background
Rarely, the first sign of chronic thromboembolic pulmonary hypertension (CTEPH) is acute embolism, an acute-on-chronic event. These patients are challenging: they need emergent care but are not candidates for immediate definitive treatment with pulmonary endarterectomy (PEA) due to their critical condition.
Case presentation
We report a patient with massive acute-on-chronic pulmonary thromboembolism leading to cardiogenic shock. We decided on a staged surgical treatment strategy: emergency surgical embolectomy; brindging and stabilization with central veno-arterial extracorporeal membrane oxygenator; and delayed PEA. The patient had full recovery.
Conclusions
Patients with an undiagnosed CTEPH developing an acute embolism are in a very high risk of facing a complicated recovery and death. A multidisciplinary team effort is warranted. A staged surgical approach with delayed PEA after stabilization seems a reasonable option to manage these rare and complex patients.
Publisher
BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
Subject
/ Edema
/ Embolism
/ Extracorporeal membrane oxygenation
/ Female
/ Heart
/ Humans
/ Hypertension, Pulmonary - surgery
/ Male
/ Mechanical cardiac assistance and replacement technology
/ Medicine
/ Patients
/ Pulmonary Artery - diagnostic imaging
/ Pulmonary Embolism - complications
/ Pulmonary Embolism - diagnosis
/ Pulmonary Embolism - surgery
/ Recovery
/ Surgery
