Rescue Surgical Embolectomy in Acute Massive Pulmonary Embolism Presenting with Supraventricular Tachycardia

Acute massive pulmonary embolism (PE) has a high mortality rate despite the advances in the diagnosis and therapy. Patients with PE need rapid diagnosis, risk stratification and an appropriate management for reducing mortality and morbidity. Patients with massive PE could be admitted to the emergency room presenting with not only dyspnea but also with predominant supraventricular tachycardia (SVT). In such case, heart rate control with drugs may be more difficult, and may lead to hemodynamic instability, in addition to the overloaded right heart depends on PE. A rapid computed tomography pulmonary angiography is demanded to confirm PE. Transthoracic echocardiography may play an important role for risk stratification of patients with PE, in order to show dilated right chambers, paradoxical movement of interventricular septum, and increased pulmonary arterial pressures presenting with the overloaded right heart. Although lifesaving treatment, thrombolytics has potential bleeding risk, especially intracranial hemorrhagia. Rescue surgical pulmonary embolectomy may be a life-saving altenative therapy in patients with massive PE who have not responded to thrombolysis. Hereby, we report a case with acute massive PE presenting with SVT, rescued via surgical embolectomy.