Rescue Balloon Pulmonary Angioplasty Under Veno-Arterial Extracorporeal Membrane Oxygenation in a Patient With Acute Exacerbation of Chronic Thromboembolic Pulmonary Hypertension
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- Nakamura Makiko
- Department of Cardiology, Okinawa Prefectural Nanbu Medical Center and Children’s Medical Center
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- Sunagawa Osahiko
- Department of Cardiology, Okinawa Prefectural Nanbu Medical Center and Children’s Medical Center
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- Tsuchiya Hiroyuki
- Department of Cardiology, Okinawa Prefectural Nanbu Medical Center and Children’s Medical Center
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- Miyara Takafumi
- Department of Cardiology, Okinawa Prefectural Nanbu Medical Center and Children’s Medical Center
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- Taba Yoji
- Department of Cardiology, Okinawa Prefectural Nanbu Medical Center and Children’s Medical Center
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- Touma Takashi
- Department of Cardiology, Okinawa Prefectural Nanbu Medical Center and Children’s Medical Center
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- Munakata Hiroshi
- Department of Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center and Children’s Medical Center
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- Kugai Tadao
- Department of Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center and Children’s Medical Center
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- Okita Yutaka
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
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抄録
We describe a case of a 41-year-old woman with acute exacerbation of chronic thromboembolic pulmonary hypertension (CTEPH) complicated by rapidly progressive respiratory failure and right heart failure with cardiogenic shock. A computed tomography (CT) showed thrombi in the right main pulmonary artery and bilateral peripheral pulmonary arteries, and echocardiography showed right ventricular dilatation and tricuspid regurgitation, with an estimated pressure gradient of 80 mmHg. The patient was initially diagnosed with acute pulmonary thromboembolism, and thrombolytic therapy was administered. Her condition subsequently deteriorated, however, necessitating mechanical ventilation and veno-arterial extracorporeal membrane oxygenation (VA-ECMO). We performed emergency catheter-directed thrombectomy and thrombus aspiration. Pulmonary hypertension (PH) temporarily improved, but subsequently worsened, and the patient was diagnosed with CTEPH. Pulmonary endarterectomy (PEA) was performed. After PEA, we were unable to wean the patient off VA-ECMO, and rescue balloon pulmonary angioplasty (BPA) to the middle and inferior lobe branches of the right lung was performed. Five days after BPA, the patient was removed from VA-ECMO and on the 57th day of hospitalization, she was weaned off the ventilator. The patient was discharged after 139 days of hospitalization. Rescue BPA represents a useful intervention for improving PH and weaning off VA-ECMO in a patient with acute exacerbation of CTEPH.
収録刊行物
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- International Heart Journal
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International Heart Journal 56 (1), 116-120, 2015
一般社団法人 インターナショナル・ハート・ジャーナル刊行会