A 28-year-old man with a history of two episodes of deep vein thrombosis (DVT) in the lower limbs during adolescence.
Emerged with a postflebitic syndrome, functional capacity (FC) I. Current history of 8 months of progressive dyspnea, which is made at rest in the last month, accompanied by distal syncope episode a, hospitalized
Computed tomography angiography (CTA) showed extensive central stenosis associated with growth of the right cavity and pulmonary artery trunk (PA).
A transthoracic echocardiogram showed right ventricular hypertrophy with suspected thrombus in the right atrium and a systolic pulmonary artery pressure (SPAP) of 70 mmHg.
Acute admission diagnoses were chronic, severe secondary PH and right heart failure, and thrombophilia was also raised.
1.
Systemic thrombolysis was initiated with streptokinase at 48 h, evolving with a clear decrease in oxygen requirements.
A transthoracic echocardiogram and control CT angiography, 7 days later, showed partial lysis of the thrombi and severe dilation of the PA.
Given the only partial improvement in dyspnea, with persistent oxygen requirements, in the context of severe PH, in February 2004 an inferior vena cava filter (IVC) and pulmonary thromboendarterectomy were installed.
The angioTAC in the immediate postoperative period showed an PA without defects and a filling auricle without thrombus.
Transthoracic echocardiogram revealed PASP 30 mmHg.
1.
She was discharged at 2 months without oxygen requirements, with negative thrombophilia study and indication for oral anticoagulant therapy.
One month after discharge, the patient was in FC I. The control echocardiogram showed normal pulmonary artery pressure.
