Need advice: Patient 37 y.o. with DVT and thrombosis of right radial artery (after coronary angio 2 weeks ago), pulmonary embolism and thrombolysis month ago. Now patient has indication for on-pump cardiac surgery - resection of postinfarction aneurysm of LV with thrombectomy (NB! Floating thrombus in the LV). Patient receives anticoagulants. Mild form of COVID-19 - 3 weeks ago.
What tactic is better to choose: operate now or wait 3-6 months after pulmonary embolism?
Thank you in advance!
If the thrombus is still present in the LV despite the anticoaguant therapy I think is better to operate on the patient now.
How long has it been since the heart attack?
Are there no coronary bypasses and / or mitral valve repair during surgery?
Patient is fit for operation or delay the operation for 3-6 month will depend on status of underlying disease conditions. Status of pulmonary embolism after thrombolysis ,either in resolving phase or as usual as earlier by use of non-invasive or non-invasive modalities. Also assess the status of LV aneurysm by 2D Echo cardiography ie expanding or static in nature. Patient having past H/O COVID . CoVID itself is a hyper coagulable state, having more chance of thrombosis of small pulmonary capillaries..As per as new COVID treatment guidelines, any patient with co morbidities, who recovered with COVID ,elective surgery should be postpone for atleast 6 month if patient is clinically stable or embolism is in resolving phase. There are many case report of incidental pulmonary embolism after CABG surgeries
Dear Antonio Capo, thank you for your answer!
Patient got post-traumatic myocardial infarction during a mine explosion in May 2022. There is no atherosclerotic lesions of coronary arteries, mitral regurgitation, EF - 47%. We decided to postpone operation on 3-6 months, cause except for thrombosis, pulmonary embolism and recent COVID-19 infarction, patient also had 4 brain contusion.
Dear Alok Kumar Bharti , thank you for your interest & answer. In 3 weeks after thrombolisis he is still has a signs of PE of pulmonary arteries and it’s segmental branches on computer tomography. There is no negative dynamics on echo study (size of ALV and EF,%), but we see decrease of pressure in pulmonary artery. The tendency to thrombosis, in addition to COVID-19, is also likely due to polytrauma, shrapnel and gunshot wounds in May 2022. So we decided to postpone the resection of aneurysm of left ventricle for 3-6 months.
I think it's Right Decision .Delay the surgery for atleast 3 month
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