Ji Jianyu, Jiang Lei, Wang Wei, Chi Xinyu, Dong Jinda, Lu Liqiu, Huang Minyan, Wei Xiutian, Pang Guangbao, Pang Jing, Xiong Bin, Xiang Shulin
Guangxi Academy of Medical Sciences, Nanning, Guangxi, China.
Department of Intensive Care Unit, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.
Front Cardiovasc Med. 2024 Jul 2;11:1409775. doi: 10.3389/fcvm.2024.1409775. eCollection 2024.
Catastrophic Antiphospholipid Syndrome (CAPS), a severe systemic autoimmune disorder, predominantly causes life-threatening multi-organ failure, with a high mortality rate. It primarily affects small vessels, seldom impacting large vessels. Notably, acute massive pulmonary embolism (PE) with bilateral atrial thrombosis is an exceptional occurrence in CAPS. Acute pulmonary embolism (PE) is a common cardiovascular disease that progresses rapidly and has a high mortality rate. Acute massive PE combined with bilateral atrial thrombosis has an even higher mortality rate. PE treatments primarily include pharmaceuticals, catheter interventions, and surgical measures, with integrated treatment strategies demonstrating promising outcomes in clinical practice. Extracorporeal membrane oxygenation (ECMO) can provide cardiopulmonary support for the treatment of high-risk PE patients and is a proven therapeutic measure.
This report presents the case of a 52-year-old male admitted due to fever and sudden onset of impaired consciousness, with cardiac ultrasound and pulmonary artery CT angiography revealing an acute large-scale pulmonary embolism accompanied by bilateral atrial thrombosis, with the condition rapidly worsening and manifesting severe respiratory and circulatory failure. With ECMO support, the patient underwent a thrombectomy using an AngioJet intervention. The diagnosis of CAPS was confirmed through clinical presentation and laboratory examination, and treatment was adjusted accordingly.
The patient made a successful recovery and was subsequently discharged from the hospital.
In CAPS patients, the rare instance of acute massive PE accompanied by bilateral atrial thrombosis significantly risks severe respiratory and circulatory failure, adversely affecting prognosis. Early initiation of ECMO therapy is crucial, offering a vital opportunity to address the root cause. In this case report the patient was successfully treated with an AngioJet thrombectomy supported by ECMO.
灾难性抗磷脂综合征（CAPS）是一种严重的全身性自身免疫性疾病，主要导致危及生命的多器官功能衰竭，死亡率很高。它主要影响小血管，很少影响大血管。值得注意的是，伴有双侧心房血栓形成的急性大面积肺栓塞（PE）在CAPS中是一种罕见情况。急性肺栓塞（PE）是一种常见的心血管疾病，进展迅速且死亡率很高。急性大面积PE合并双侧心房血栓形成的死亡率更高。PE治疗主要包括药物治疗、导管介入治疗和手术措施，综合治疗策略在临床实践中显示出良好的效果。体外膜肺氧合（ECMO）可为高危PE患者的治疗提供心肺支持，是一种经过验证的治疗措施。
本报告介绍了一名52岁男性患者的病例，该患者因发热和意识突然障碍入院，心脏超声和肺动脉CT血管造影显示急性大面积肺栓塞伴双侧心房血栓形成，病情迅速恶化并出现严重呼吸和循环衰竭。在ECMO支持下，患者接受了AngioJet介入血栓切除术。通过临床表现和实验室检查确诊为CAPS，并相应调整治疗方案。
患者成功康复，随后出院。
在CAPS患者中，急性大面积PE伴双侧心房血栓形成这种罕见情况会显著增加严重呼吸和循环衰竭的风险，对预后产生不利影响。尽早开始ECMO治疗至关重要，为解决根本问题提供了重要机会。在本病例报告中，患者在ECMO支持下通过AngioJet血栓切除术成功治愈。
