SHM Converge Scientific Abstract ePoster Gallery-Right Ventricular Dopple Envelope, Not Right Ventricular Systolic Pressure, for Assessing Response to Treatment of High-Risk Pulmonary Embolism With Thrombectomy and Tissue Plasminogen Activator

Right Ventricular Dopple Envelope, Not Right Ventricular Systolic Pressure, for Assessing Response to Treatment of High-Risk Pulmonary Embolism With Thrombectomy and Tissue Plasminogen Activator

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This case report describes a 62-year-old man who presented with chest pain and shortness of breath after a long drive and was found to have a large saddle pulmonary embolism (PE) with right heart strain. Initial echocardiography showed early systolic notching of the right ventricular outflow tract (RVOT) Doppler envelope, along with right atrial and right ventricular dilation and impaired right ventricular function. Although right ventricular systolic pressure (RVSP) was only mildly elevated, the RVOT waveform suggested increased pulmonary vascular resistance and significant hemodynamic burden.<br /><br />He underwent emergent bilateral suction thrombectomy, but the procedure was complicated by brief cardiac arrest and discovery of a thrombus in transit, prompting administration of tissue plasminogen activator (tPA). His course was further complicated by hemopericardium and cardiac tamponade, requiring pericardiocentesis. After treatment and stabilization, repeat echocardiography showed resolution of the RVOT notching, suggesting improvement in pulmonary vascular resistance and response to therapy. Interestingly, RVSP increased despite clinical improvement, highlighting its limitations as a marker of treatment response.<br /><br />The authors emphasize that RVOT Doppler envelope shape, especially early systolic notching, may be a more specific and useful echocardiographic marker than RVSP for diagnosing acute PE and monitoring response to treatment. They propose that persistent RVOT notching after intervention may indicate inadequate treatment response. The patient was later found to have heterozygous Factor V Leiden mutation and was discharged on long-term apixaban anticoagulation.

Asset Subtitle

Zachary Breslow

Meta Tag

Author List Andrea Rodriguez Jimenez, James Brown, Jason Baluja, Shrinand Shah, Zachary Breslow

Category Clinical Vignettes

Concept Right Ventricular Outflow Tract Doppler Envelope Shape

Concept Early Systolic Notching

Concept Acute High-Risk Pulmonary Embolism

Concept Echocardiography

Concept Postvoid Residual

Distinguished Non-Finalist

Presenter Organization Lakeland Regional Health

Presenting Author Zachary Breslow

Track Adult

Keywords

pulmonary embolism

saddle embolism

right heart strain

RVOT Doppler notching

echocardiography

suction thrombectomy

tissue plasminogen activator

cardiac tamponade

Factor V Leiden

apixaban

Right Ventricular Outflow Tract Doppler Envelope Shape

Early Systolic Notching

Acute High-Risk Pulmonary Embolism

Echocardiography

Postvoid Residual