© 2014, Wiley Periodicals, Inc. DOI: 10.1111/joic.12169

CLINICAL IMAGES Ablation Catheter for Treatment of Acute Pulmonary Embolism JAKUB. BARAN, 1 ARKADIUSZ RAK, 2 and PIOTR KULAKOWSKI 1 From the 1Department of Cardiology, Division of Clinical Electrophysiology, Postgraduate Medical, School Grochowski Hospital, Warsaw, Poland; and 2Centrum of Cardiology, Józefów, Poland

A 78 year old female with a history of pulmonary embolism was admitted to hemodynamic laboratory due to STEMI-ECG showing ST segment elevation of 1.5 mm in leads II, III, aVF and V4-V5. She had chest pain, dyspnea, low blood pressure — 80/60 mmHg, and reduced blood saturation – 70%. Coronary angiography showed no significant narrowing of coronary arteries. Next, pulmonary artery (PA) angiography was performed and massive embolization of the right PA (RPA) was found (Fig. 1A). Thrombolysis was not performed because of a history of serious bleeding. The decision was made to mechanically fragment the thrombus, however, it was not

possible to enter RPA with standard hemodynamic catheters. Eventually, ablation catheter (AlCath Gold, Biotronic), crossed thrombus and was advanced into RPA (Fig. 1B). This manoeuver enabled a pig-tail catheter to enter the RPA (Fig. 1C). Subsequently, thrombus fragmentation with both ablation and pig-tail catheters was performed (Fig. 1D). Blood pressure and oxygen saturation immediately increased to: 110/ 80 mmHg and – 92%, respectively. This report shows that standard hemodynamic catheters may be too soft to cross and mechanically destroy a thrombus in PA. In such situation, more stiff and steerable catheters like an ablation catheter may occur effective.

Address for reprints: J. Baran, Department of Cardiology, Postgraduate Medical School Grochowski Hospital, Division of Clinical Electrophysiology, Grenadierów 51/59, 04-073, Warsaw, Poland. Fax: (þ48) 22 5152676; e-mail: [email protected]

Vol. 9999, No. 9999, 2014

Journal of Interventional Cardiology

1

BARAN ET AL.

Figure 1. Fluoroscopic images showing (A) massive embolization of the right pulmonary artery (RPA), (B) crossing the thrombus with an ablation catheter, (C) entering the RPA with a pigtail catheter, and restoration of the RPA potency after thrombus fragmentation.

2

Journal of Interventional Cardiology

Vol. 9999, No. 9999, 2014

Ablation Catheter for Treatment of Acute Pulmonary Embolism.

Ablation Catheter for Treatment of Acute Pulmonary Embolism. - PDF Download Free
441KB Sizes 0 Downloads 10 Views