Flotirajući tromb desne pretkomore udružen sa submasivnom embolijom pluća
Sažetak
Uvod. Masivni flotirajući trombovi u desnom srcu retko se viđaju u svakodnevnoj kliničkoj praksi, a najčešće su rezultat embolizacije trombotičnim masama iz vena donjih ekstremiteta. Trombovi u desnom srcu predstavljaju veliki rizik za nastanak submasivne ili masivne embolije pluća, zbog čega je važno rano ih dijagnostikovati i adekvatno lečiti. Prikaz bolesnika. Prikazan je 56-godišnji bolesnik kod kojeg je nastala submasivna plućna embolija na terenu velikog flotirajućeg tromba u desnom srcu koji je brzo dijagnostikovan ehokardiografijom. Bolesnik je na prijemu bio hemodinamski stabilan sa vrednostima krvnog pritiska 140/100 mmHg. Inicijalna procena rizika učinjena je pomoću skora Pulmonary Embolism Severity Index koji je iznosio 86 što je bolesnika svrstalo u klasu III, odnosno umereni rizik od mortaliteta unutar 30 dana od događaja. S obzirom na to da je bolesnik bio hemodinamski stabilan, a imajući u vidu masivnost tromba u desnim srčanim šupljinama, nije primenjena trombolitička terapija zbog rizika od rasipanja trombnih masa, dodatne embolizacije i hemodinamskog opterećenja plućne cirkulacije. Nije bilo moguće razmatrati katetersku proceduru s obzirom na to da se takva vrsta procedure ne radi u centru gde je bolesnik lečen. Zbog svega prethodno navedenog, odlučeno je da je hirurška trombektomija najprihvatljivije i po bolesnika najbezbednije rešenje. Hirurška trombektomija je uspešno obavljena. Postoperativni tok protekao je bez komplikacija i bolesnik se brzo oporavio. Zaključak. Masivna plućna embolija udružena sa trombozom desnog srca povezana je sa visokim mortalitetom. Ovaj slučaj ističe važnost brze dijagnoze, multidisciplinarnog pristupa, pravovremenog donošenja odluke i individualizovanog lečenja, čime se smanjuje smrtnost ovih bolesnika.
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