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      Submassive pulmonary thromboembolism, post-COVID sequelae; with mechanical thrombus aspiration and accelerated thrombolysis by Ekos ultrasound with successful resolution

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          Abstract

          Introduction

          Acute pulmonary thromboembolism is a pulmonary pathology that is becoming more frequent nowadays, the use of new mechanical and thrombolytic therapies has a significant impact on the cardiopulmonary prognosis.

          Case

          A 41-year-old male, a retired military man, smoking, overweight, dyslipidemia, alcoholic liver disease, who attended the emergency department due to abrupt dyspnea, with tachycardia, chest pain, and syncope; the patient had tachycardia of 120 bpm, BP 90/60 mmHg and SO 2 of 82%, with a history of COVID-19 infection, suspected of massive pulmonary embolism, it was decided to carry out computed tomography where a bilateral submassive pulmonary embolism was documented ( Fig. 1A), it was proposed to perform systemic thrombolysis, however due to the risk of bleeding, it was decided to perform EKOS ultrasound directed thrombolysis. Baseline pulmonary angiography was performed with a large number of thrombi ( Fig. 1B), distributed in both main right and left branches and deficient pulmonary filling of distal vessels, due to the large amount of thrombus, it was decided to perform manual thrombus aspiration, obtaining a large amount of thrombus ( Fig. 1C), as well as thrombolysis in situ with Alteplase a dose of 1 mg/catheter/hour for 12 hours, with a total dose of 24 mg; Ultrasound probe was placed in both pulmonary arteries with the EKOS system ( Fig. 1D).

          Results

          Pulmonary angiography was performed 24 hours after the procedure, where no bleeding occurred and almost complete resolution of the thrombus was observed. The patient later with 92% SO 2, without oxygen requirements, with HR 90 bpm, with no evidence of ventricular dysfunction, was discharged home with anticoagulation.

          Conclusion

          Low dose fibrinolysis and thromboaspiration are considered, as well as the use of EKOS endovascular ultrasound, a safe and effective procedure, in the context of a patient with high-risk of bleeding, with favorable results that condition clinical and prognostic improvement.

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          Author and article information

          Journal
          Archives of Cardiovascular Diseases. Supplements
          Published by Elsevier Masson SAS
          1878-6480
          1878-6502
          27 December 2021
          January 2022
          27 December 2021
          : 14
          : 1
          : 97
          Affiliations
          [1 ]Cath Lab, Central Military Hospital, Mexico City, Mexico
          [2 ]Anestesiology, Center Medical Navy, Mexico, Mexico
          Author notes
          [* ]Corresponding author.
          Article
          S1878-6480(21)00572-3
          10.1016/j.acvdsp.2021.09.214
          8710973
          4f8430b5-b92a-4b38-95c8-660477fcb756
          Copyright © 2021 Published by Elsevier Masson SAS.

          Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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