Emergent percutaneous mechanical thrombectomy provided rapid hemodynamic and oxygenation improvement in a 71-year-old woman with acute cor pulmonale from massive saddle pulmonary embolism.
Case Report (n=1)
Percutaneous mechanical thrombectomy can serve as an effective, lifesaving rescue therapy for massive pulmonary embolism with acute cor pulmonale in postoperative patients where systemic thrombolysis is contraindicated.
Abstract Introduction Acute cor pulmonale resulting from massive pulmonary embolism (PE) is a life-threatening emergency characterized by abrupt right ventricular (RV) failure from sudden RV afterload increase. Management is uniquely challenging in postoperative patients at high hemorrhagic risk, where systemic thrombolysis is contraindicated. We report a case of massive PE with right ventricular (RV) dysfunction in a patient with recent pelvic surgery and ongoing anticoagulation, managed successfully with percutaneous mechanical thrombectomy. Case Description A 71-year-old female with postmenopausal bleeding and biopsy-confirmed endometrial intraepithelial neoplasia was admitted for symptomatic anemia before planned surgery. Preoperative imaging revealed a uterine mass concerning for malignancy, pelvic adenopathy, and right ovarian vein thrombosis. Lower-extremity duplex demonstrated superficial thrombophlebitis without deep vein thrombosis, and she was started on therapeutic heparin. She underwent pelvic lymphadenectomy converted to open total abdominal hysterectomy with bilateral salpingo-oophorectomy and debulking. Postoperatively, she developed a rectus sheath hematoma, and anticoagulation was held temporarily, then resumed at a prophylactic dose. On postoperative day 2, she experienced sudden syncope, hypotension, hypoxia, and tachypnea. Labs revealed elevated troponin and NT-proBNP. CTA demonstrated extensive bilateral pulmonary emboli with a saddle component and severe RV strain. Transthoracic echocardiography showed a markedly dilated RV with severely reduced systolic function and McConnell’s sign, consistent with acute cor pulmonale. Given recent surgery, anemia, and bleeding risk, systemic thrombolysis was contraindicated. She underwent emergent percutaneous mechanical thrombectomy with temporary IVC filter placement, resulting in rapid hemodynamic and oxygenation improvement, without the need for vasopressor support. Therapeutic anticoagulation was resumed post-procedure, and she was discharged in stable condition on apixaban to inpatient rehabilitation. Discussion This case highlights the development of acute cor pulmonale as a critical manifestation of massive PE, even in patients on anticoagulation. Recognition of severe RV dysfunction and McConnell’s sign facilitated prompt intervention. Mechanical thrombectomy provided immediate RV unloading and reversal of cor pulmonale physiology, emphasizing its role as a lifesaving therapy when thrombolysis is contraindicated. This case underscores the importance of early identification of acute RV failure and multidisciplinary management in high-risk postoperative patients. This abstract is funded by: None
Shah et al. (Fri,) conducted a case report in Massive saddle pulmonary embolism with acute cor pulmonale (n=1). Percutaneous mechanical thrombectomy was evaluated on Hemodynamic and oxygenation improvement. Emergent percutaneous mechanical thrombectomy provided rapid hemodynamic and oxygenation improvement in a 71-year-old woman with acute cor pulmonale from massive saddle pulmonary embolism.