Koroner Baypas Cerrahisi Sonrası Erken Dönemde Gelişen Masif Pulmoner Emboli ve Tedavisi

Yıl 2015, Cilt: 5 Sayı: 3, 180 - 185, 11.12.2015

Hüseyin Şaşkın Çağrı Düzyol Rezan Aksoy Atike Tekeli Kunt

Öz

Asemptomatik venöz tromboembolizm koroner baypas cerrahisi sonrası şaşırtıcı olarak sık görülmektedir. Çoğu durumda klinik olarak önemli olmasa da, derin ven trombozu ve pulmoner emboli gibi hayatı tehdit edici, morbiditesi ve mortalitesi yüksek olan klinik durumların ön habercisi de olabilmektedir. Koroner baypas cerrahisi sonrası pulmoner tromboemboli nadir rastlanan komplikasyonlardan biridir. Standart bir tedavi protokolü olmamasına rağmen; erken tanı konulması ve tedavinin erken başlanması başarılı bir sonuç için hayati önem taşımaktadır. Olgumuz; 63 yaşında erkek hasta, kardiyopulmoner baypas ile koroner arter baypas greftleme ameliyatı yapıldı. Ameliyat sonrası 3. gününde serviste mobilize olurken ani senkop sonrası solunum ve kardiyak arrest gelişti. Hastaya yapılan transtorasik ekokardiyografide sağ ventrikül apeksinde trombüs materyali, spiral bilgisayarlı tomografide ise her iki pulmoner arterde trombüs saptandı. Akut pulmoner emboli tanısı konulan hastaya trombolitik tedavi başlandı. Tedavinin 48. saatinde hastanın klinik ve radyolojik bulgularının düzeldiği gözlendi. Bu yazımızda, koroner arter baypas ameliyatı sonrası erken dönemde etyolojik nedeninin sağ ventriküldeki trombüs olduğu düşünülen, masif (yüksek riskli) pulmoner emboli gelişen vakada uygulanan trombolitik tedavi ve etkinliğini sunmayı amaçladık.

Anahtar Kelimeler

Koroner arter baypas, pulmoner emboli, trombolitik tedavi

Massive Pulmonary Embolism in the Early Postoperative Period Following Coronary Artery Bypass Surgery

Öz

Asymptomatic venous thromboembolism is surprisingly frequent following coronary artery bypass surgery. In most cases, this situation is not clinically important, however it may lead to clinical conditions such as deep venous thrombosis and pulmonary embolism which are life threatening with high morbidity and mortality. Pulmonary thromboembolism following coronary artery bypass surgery is a rare complication. Although there is not a standard therapy protocol, early diagnose and therapeutic approach are vitally important for a successful result. Sixty three year old male patient was operated coronary artery bypass grafting with cardiopulmonary bypass. Respiratory and cardiac arrest following sudden syncope occured during mobilization on the 3rd postoperative day in the inpatient clinic. The transthoracic echocardiographic imaging revealed thrombus in the apical segment of the right ventricle, and thrombus in bilateral pulmonary arteries were found in the spiral computerized tomography scan. Thrombolytic therapy was administered with the diagnosis of acute pulmonary embolism. The clinical and radiological findings were resolved on the 48th hour of therapy. In this paper, we aimed to present thrombolytic therapy and its efficiency in a case of massive (high risk) pulmonary embolism in the early postoperative period following coronary artery bypass surgery for which the ethiologic factor was thought to be the thrombus in the right ventricle.

Anahtar Kelimeler

Coronary artery bypass, pulmonary embolism, thrombolytic therapy

Kaynakça

• Roy PM, Meyer G, Vielle B, Le Gall C, Verschuren F, Carpentier F et al. Appropriateness of diagnostic management and outcomes of suspected pulmonary embolism. Ann Intern Med 2006;144:157–164.
• Goldhaber SZ, Hirsch DR, MacDougall RC, Polak JF, Creager MA, Cohn LH. Prevention of venous thrombosis after coronary artery bypass surgery (a randomized trial comparing two mechanical prophylaxis strategies). Am J Cardiol 1995;76:993-996.
• Reis SE, Polak JF, Hirsch DR, Cohn LH, Creager MA, Donovan BC et al. Frequency of deep vein thrombosis in asymptomatic patients with coronary artery bypass grafs. Am J Cardiol 1991;122:478-482
• Heit JA. The epidemiology of venous thromboembolism in the
• community: implications for prevention and management. J Thromb Thrombolysis 2006;21: 23-29.
• Kara İ, Ay Y, Aydın C, Kahraman Ay N, Yıldırım T: [Pulmonary embolism be caused by deep venous thrombosis after coronary artery bypass grafting]. Medical Journal of Kocaeli 2012;3:27-30.
• Laporte S, Mismetti P, Decousus H, Uresandi F, Otero R, Lobo JL, et al. Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry. Circulation 2008;117:1711-1716.
• Meneveau N, Séronde MF, Blonde MC, Legalery P, DidierPetit K, Briand F, et al. Management of unsuccessful thrombolysis in acute massive pulmonary embolism. Chest 2006 ;129:1043-1050.
• Rafique M, Middlemost S, Skoularigis J, Sareli P . Simultaneous mechanical clot fragmentation and pharmacologic thrombolysis in acute massive pulmonary embolism. Am J Cardiol 1992;69:427-430.
• Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 2008;29:2276-2315.
• Wittine LM, Auger WR. Chronic Thromboembolic Pulmonary Hypertension. Curr Treat Options Cardiovasc Med 2010;12:131-141.