Siebenlist D, Gattenlöhner W
Medizinische Klinik I, Leopoldina-Krankenhauses Schweinfurt.
Dtsch Med Wochenschr. 1993 Aug 6;118(31):1105-9. doi: 10.1055/s-2008-1059432.
Ten days after surgical treatment of a gastric perforation a 70-year-old woman developed progressive dyspnoea and hypertension without any signs of deep vein thrombosis. Emergency echocardiography revealed acute cor pulmonale with a dilated right atrium and ventricle, as well as paradoxical ventricular septal motion. In addition it demonstrated an elongated, extremely mobile thrombus stuck in a patent foramen ovale with most of it floating in the right atrium, the remainder in the left atrium. Within 2 hours of the ultrasound examination she went into fulminant pulmonary embolism with circulatory arrest and paradoxical embolization from the atria to the brain, after which the intraatrial thrombus was no longer detectable. She was successfully resuscitated and thrombolysis was immediately started with tissue-plasminogen activator (100 mg over 90 min), with ensuing stabilization of the circulation. The patient was gradually weaned off the ventilator over the following few days, but she died 10 days after the resuscitation from the severe cerebral damage.
一名70岁女性在胃穿孔手术治疗10天后出现进行性呼吸困难和高血压，无深静脉血栓形成的任何迹象。急诊超声心动图显示急性肺心病，右心房和右心室扩张，以及室间隔矛盾运动。此外，还发现一个细长的、活动度极大的血栓嵌顿在卵圆孔未闭处，大部分血栓漂浮在右心房，其余部分在左心房。超声检查后2小时内，她发生了暴发性肺栓塞，伴有循环骤停和自心房至脑的反常栓塞，此后心房内血栓不再可检测到。她成功复苏，并立即开始用组织型纤溶酶原激活剂进行溶栓治疗（90分钟内给予100毫克），随后循环稳定。在接下来的几天里，患者逐渐脱机，但复苏后10天因严重脑损伤死亡。
