Mechanical breakdown and thrombosuction of mobile clot in right ventricular outflow tract causing massive pulmonary embolism in a patient with absolute contraindication to thrombolysis

Abstract

Massive pulmonary embolism (PE) carries high mortality if not treated urgently. Survival depends on rapid recanalization of pulmonary artery and reduction of right ventricular overload. Historically, surgical pulmonary embolectomy has remained as cornerstone of treatment, but in recent times, catheter-directed techniques are gaining popularity especially in centers of expertise and main indication for surgery remains only in few cases in which there is presence of intracardiac mobile clot (in right atrium, right ventricle, or right ventricular outflow tract [RVOT]) or in cases with contraindications to local/systemic thrombolysis or as rescue operation where there is failure of catheter-directed techniques. The role of mechanical breakdown and other catheter-directed therapies as a potential alternative and role in patients with RVOT thrombus is debatable. We report a case where a patient with massive PE with RVOT thrombus having contraindication to thrombolysis managed successfully with catheter-directed mechanical breakdown and thrombosuction.

Keywords

• massive pulmonary embolism
• mechanical breakdown
• mobile thrombus