array:25 [
  "pii" => "S2174204915002627"
  "issn" => "21742049"
  "doi" => "10.1016/j.repce.2015.11.009"
  "estado" => "S300"
  "fechaPublicacion" => "2015-11-01"
  "aid" => "718"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2015"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "sco"
  "cita" => "Rev Port Cardiol. 2015;34:703-4"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 2186
    "formatos" => array:3 [
      "EPUB" => 150
      "HTML" => 1652
      "PDF" => 384
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:20 [
      "pii" => "S0870255115002486"
      "issn" => "08702551"
      "doi" => "10.1016/j.repc.2015.06.009"
      "estado" => "S300"
      "fechaPublicacion" => "2015-11-01"
      "aid" => "718"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "sco"
      "cita" => "Rev Port Cardiol. 2015;34:703-4"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 2290
        "formatos" => array:3 [
          "EPUB" => 185
          "HTML" => 1526
          "PDF" => 579
        ]
      ]
      "en" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>"
        "titulo" => "Diagnosis and management of pulmonary embolism in critical situations&#58; A cardiac challenge"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "703"
            "paginaFinal" => "704"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Embolia pulmonar em pacientes cr&#237;ticos&#58; desafio card&#237;aco"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0020"
            "etiqueta" => "Figure 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 750
                "Ancho" => 526
                "Tamanyo" => 67804
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Mid-esophageal right ventricular inflow-outflow view before &#40;A&#44; with right ventricular dilatation and severe tricuspid regurgitation&#41; and after percutaneous thrombectomy &#40;B&#44; with normal size right ventricle and resolution of tricuspid regurgitation&#41;&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Juan Caro-Cod&#243;n, Teresa L&#243;pez-Fern&#225;ndez, &#193;ngel S&#225;nchez-Recalde, Silvia Valbuena-L&#243;pez, Ra&#250;l Moreno, Jos&#233; Luis L&#243;pez-Send&#243;n"
            "autores" => array:6 [
              0 => array:2 [
                "nombre" => "Juan"
                "apellidos" => "Caro-Cod&#243;n"
              ]
              1 => array:2 [
                "nombre" => "Teresa"
                "apellidos" => "L&#243;pez-Fern&#225;ndez"
              ]
              2 => array:2 [
                "nombre" => "&#193;ngel"
                "apellidos" => "S&#225;nchez-Recalde"
              ]
              3 => array:2 [
                "nombre" => "Silvia"
                "apellidos" => "Valbuena-L&#243;pez"
              ]
              4 => array:2 [
                "nombre" => "Ra&#250;l"
                "apellidos" => "Moreno"
              ]
              5 => array:2 [
                "nombre" => "Jos&#233; Luis"
                "apellidos" => "L&#243;pez-Send&#243;n"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2174204915002627"
          "doi" => "10.1016/j.repce.2015.11.009"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915002627?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115002486?idApp=UINPBA00004E"
      "url" => "/08702551/0000003400000011/v1_201511060141/S0870255115002486/v1_201511060141/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S2174204915002111"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2015.09.006"
    "estado" => "S300"
    "fechaPublicacion" => "2015-11-01"
    "aid" => "698"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "cor"
    "cita" => "Rev Port Cardiol. 2015;34:705-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2066
      "formatos" => array:3 [
        "EPUB" => 129
        "HTML" => 1516
        "PDF" => 421
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "Comment on &#8220;Cost-effectiveness of rivaroxaban for stroke prevention in atrial fibrillation in the Portuguese setting&#8221;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "705"
          "paginaFinal" => "706"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Coment&#225;rio a estudo de custo-efetividade de rivaroxabano para preven&#231;&#227;o de acidente vascular cerebral em doentes com fibrilha&#231;&#227;o auricular em Portugal"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Lu&#237;s Silva Miguel"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "Lu&#237;s"
              "apellidos" => "Silva Miguel"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S0870255115002280"
        "doi" => "10.1016/j.repc.2015.03.022"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115002280?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915002111?idApp=UINPBA00004E"
    "url" => "/21742049/0000003400000011/v2_201703180236/S2174204915002111/v2_201703180236/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S2174204915002068"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2015.09.001"
    "estado" => "S300"
    "fechaPublicacion" => "2015-11-01"
    "aid" => "702"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "sco"
    "cita" => "Rev Port Cardiol. 2015;34:701-2"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2569
      "formatos" => array:3 [
        "EPUB" => 191
        "HTML" => 1963
        "PDF" => 415
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>"
      "titulo" => "Giant right coronary aneurysm untreatable by percutaneous intervention"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "701"
          "paginaFinal" => "702"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Aneurisma gigante e intrat&#225;vel percutaneamente da coron&#225;ria direita"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 700
              "Ancho" => 700
              "Tamanyo" => 75548
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The guide wire crossed the side mesh of the stent&#44; but the balloon could not be advanced&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Bruno Marmelo, Anne Delgado, Davide Moreira, Jo&#227;o Pipa, Pedro Ferreira, Oliveira Santos"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Bruno"
              "apellidos" => "Marmelo"
            ]
            1 => array:2 [
              "nombre" => "Anne"
              "apellidos" => "Delgado"
            ]
            2 => array:2 [
              "nombre" => "Davide"
              "apellidos" => "Moreira"
            ]
            3 => array:2 [
              "nombre" => "Jo&#227;o"
              "apellidos" => "Pipa"
            ]
            4 => array:2 [
              "nombre" => "Pedro"
              "apellidos" => "Ferreira"
            ]
            5 => array:2 [
              "nombre" => "Oliveira"
              "apellidos" => "Santos"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S0870255115002322"
        "doi" => "10.1016/j.repc.2015.02.006"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115002322?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915002068?idApp=UINPBA00004E"
    "url" => "/21742049/0000003400000011/v2_201703180236/S2174204915002068/v2_201703180236/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>"
    "titulo" => "Diagnosis and management of pulmonary embolism in critical situations&#58; A cardiac challenge"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "703"
        "paginaFinal" => "704"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Juan Caro-Cod&#243;n, Teresa L&#243;pez-Fern&#225;ndez, &#193;ngel S&#225;nchez-Recalde, Silvia Valbuena-L&#243;pez, Ra&#250;l Moreno, Jos&#233; Luis L&#243;pez-Send&#243;n"
        "autores" => array:6 [
          0 => array:4 [
            "nombre" => "Juan"
            "apellidos" => "Caro-Cod&#243;n"
            "email" => array:1 [
              0 => "juancarocd&#64;gmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "Teresa"
            "apellidos" => "L&#243;pez-Fern&#225;ndez"
          ]
          2 => array:2 [
            "nombre" => "&#193;ngel"
            "apellidos" => "S&#225;nchez-Recalde"
          ]
          3 => array:2 [
            "nombre" => "Silvia"
            "apellidos" => "Valbuena-L&#243;pez"
          ]
          4 => array:2 [
            "nombre" => "Ra&#250;l"
            "apellidos" => "Moreno"
          ]
          5 => array:2 [
            "nombre" => "Jos&#233; Luis"
            "apellidos" => "L&#243;pez-Send&#243;n"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servi&#231;o de Cardiologia&#44; Hospital Universitario La Paz&#44; Madrid&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Embolia pulmonar em pacientes cr&#237;ticos&#58; desafio card&#237;aco"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 751
            "Ancho" => 764
            "Tamanyo" => 138333
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Pre- &#40;A&#41; and post-intervention &#40;B&#41; angiography of the right pulmonary artery&#46; Abundant thrombotic material was retrieved &#40;C&#41;&#46; Chest radiograph &#40;D&#41; showed wedge-shaped pleural based opacities &#40;&#8220;Hampton&#39;s hump&#8221;&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 40-year-old woman was admitted to the intensive care unit after extensive thoracic burns&#46; During surgical debridement&#44; she experienced rapidly progressive hypoxemia and hypotension requiring high-dose vasopressors&#44; and oxygen saturation remained low despite 100&#37; inspired oxygen concentration&#46; Three-dimensional transesophageal echocardiography was performed&#44; which showed a large thrombus in the right pulmonary artery&#44; extending from the main pulmonary artery bifurcation &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 1</a>&#41;&#46; It also revealed right ventricular dilatation and severe tricuspid regurgitation &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Figure 2</a>A&#41;&#46; Given the high bleeding risk associated with recent surgery&#44; a decision was made to perform percutaneous thrombectomy with low-dose intra-arterial fibrinolysis instead of systemic full-dose thrombolysis&#46; Pre-intervention angiography demonstrated a large filling defect in the right pulmonary artery with impaired distal flow &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Figure 3</a>A&#41;&#46; Abundant thrombotic material was obtained &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Figure 3</a>C&#41; and significant improvement in pulmonary circulation was noted &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Figure 3</a>B&#41;&#46; After the procedure&#44; the patient experienced a dramatic improvement in hemodynamic and respiratory parameters&#44; enabling discontinuation of vasopressors and the use of lower inspired oxygen concentration&#46; Chest radiography demonstrated wedge-shaped pleural based opacities &#40;the &#8220;Hampton&#39;s hump&#8221; sign&#44; <a class="elsevierStyleCrossRef" href="#fig0025">Figure 3</a>D&#41;&#46; Follow-up echocardiography performed 48 hours later showed resolution of right ventricular dilatation and tricuspid regurgitation &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Figure 2</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Transesophageal echocardiography is useful in the diagnosis of pulmonary embolism in critically ill patients&#46; It may show signs of right ventricular overload and enables direct visualization of thrombi in the right heart or the pulmonary artery&#46; High-risk patients &#40;e&#46;g&#46; those with hemodynamic instability&#41; usually benefit from thrombolytic therapy&#44; but percutaneous techniques are a reasonable alternative when there is significant risk of major bleeding&#46;</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:2 [
        0 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conflicts of interest"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-04-16"
    "fechaAceptado" => "2015-06-07"
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 751
            "Ancho" => 773
            "Tamanyo" => 111866
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Mid-esophageal orthogonal views of the superior vena cava &#40;SVC&#41;&#44; ascending aorta &#40;AO&#41; and right pulmonary artery&#46; Three-dimensional &#40;3D&#41; transesophageal echocardiography shows a large thrombus in the right pulmonary artery &#40;white arrow&#41;&#44; extending from the main pulmonary artery bifurcation&#46; 3D reconstruction improves the morphological characterization of the thrombus&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 751
            "Ancho" => 527
            "Tamanyo" => 78583
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Mid-esophageal right ventricular inflow-outflow view before &#40;A&#44; with right ventricular dilatation and severe tricuspid regurgitation&#41; and after percutaneous thrombectomy &#40;B&#44; with normal size right ventricle and resolution of tricuspid regurgitation&#41;&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 751
            "Ancho" => 764
            "Tamanyo" => 138333
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Pre- &#40;A&#41; and post-intervention &#40;B&#41; angiography of the right pulmonary artery&#46; Abundant thrombotic material was retrieved &#40;C&#41;&#46; Chest radiograph &#40;D&#41; showed wedge-shaped pleural based opacities &#40;&#8220;Hampton&#39;s hump&#8221;&#41;&#46;</p>"
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21742049/0000003400000011/v2_201703180236/S2174204915002627/v2_201703180236/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9915"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Images in cardiology"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003400000011/v2_201703180236/S2174204915002627/v2_201703180236/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915002627?idApp=UINPBA00004E"
]
Share
Journal Information
Vol. 34. Issue 11.
Pages 703-704 (November 2015)
Share
Share
Download PDF
More article options
Vol. 34. Issue 11.
Pages 703-704 (November 2015)
Image in Cardiology
Open Access
Diagnosis and management of pulmonary embolism in critical situations: A cardiac challenge
Embolia pulmonar em pacientes críticos: desafio cardíaco
Visits
4781
Juan Caro-Codón
Corresponding author
juancarocd@gmail.com

Corresponding author.
, Teresa López-Fernández, Ángel Sánchez-Recalde, Silvia Valbuena-López, Raúl Moreno, José Luis López-Sendón
Serviço de Cardiologia, Hospital Universitario La Paz, Madrid, Spain
This item has received

Under a Creative Commons license
Article information
Full Text
Download PDF
Statistics
Figures (3)
Show moreShow less
Full Text

A 40-year-old woman was admitted to the intensive care unit after extensive thoracic burns. During surgical debridement, she experienced rapidly progressive hypoxemia and hypotension requiring high-dose vasopressors, and oxygen saturation remained low despite 100% inspired oxygen concentration. Three-dimensional transesophageal echocardiography was performed, which showed a large thrombus in the right pulmonary artery, extending from the main pulmonary artery bifurcation (Figure 1). It also revealed right ventricular dilatation and severe tricuspid regurgitation (Figure 2A). Given the high bleeding risk associated with recent surgery, a decision was made to perform percutaneous thrombectomy with low-dose intra-arterial fibrinolysis instead of systemic full-dose thrombolysis. Pre-intervention angiography demonstrated a large filling defect in the right pulmonary artery with impaired distal flow (Figure 3A). Abundant thrombotic material was obtained (Figure 3C) and significant improvement in pulmonary circulation was noted (Figure 3B). After the procedure, the patient experienced a dramatic improvement in hemodynamic and respiratory parameters, enabling discontinuation of vasopressors and the use of lower inspired oxygen concentration. Chest radiography demonstrated wedge-shaped pleural based opacities (the “Hampton's hump” sign, Figure 3D). Follow-up echocardiography performed 48 hours later showed resolution of right ventricular dilatation and tricuspid regurgitation (Figure 2B).

Figure 1.

Mid-esophageal orthogonal views of the superior vena cava (SVC), ascending aorta (AO) and right pulmonary artery. Three-dimensional (3D) transesophageal echocardiography shows a large thrombus in the right pulmonary artery (white arrow), extending from the main pulmonary artery bifurcation. 3D reconstruction improves the morphological characterization of the thrombus.

(0.11MB).
Figure 2.

Mid-esophageal right ventricular inflow-outflow view before (A, with right ventricular dilatation and severe tricuspid regurgitation) and after percutaneous thrombectomy (B, with normal size right ventricle and resolution of tricuspid regurgitation).

(0.07MB).
Figure 3.

Pre- (A) and post-intervention (B) angiography of the right pulmonary artery. Abundant thrombotic material was retrieved (C). Chest radiograph (D) showed wedge-shaped pleural based opacities (“Hampton's hump”).

(0.13MB).

Transesophageal echocardiography is useful in the diagnosis of pulmonary embolism in critically ill patients. It may show signs of right ventricular overload and enables direct visualization of thrombi in the right heart or the pulmonary artery. High-risk patients (e.g. those with hemodynamic instability) usually benefit from thrombolytic therapy, but percutaneous techniques are a reasonable alternative when there is significant risk of major bleeding.

Ethical disclosuresProtection of human and animal subjects

The authors declare that no experiments were performed on humans or animals for this study.

Confidentiality of data

The authors declare that no patient data appear in this article.

Right to privacy and informed consent

The authors declare that no patient data appear in this article.

Conflicts of interest

The authors have no conflicts of interest to declare.

Copyright © 2015. Sociedade Portuguesa de Cardiologia
Download PDF
Idiomas
Revista Portuguesa de Cardiologia (English edition)
Article options
Tools
en pt

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

By checking that you are a health professional, you are stating that you are aware and accept that the Portuguese Journal of Cardiology (RPC) is the Data Controller that processes the personal information of users of its website, with its registered office at Campo Grande, n.º 28, 13.º, 1700-093 Lisbon, telephone 217 970 685 and 217 817 630, fax 217 931 095, and email revista@spc.pt. I declare for all purposes that the information provided herein is accurate and correct.