PMC4913996_01
Chest X-rays on venovenous extracorporeal membrane oxygenation (VV-ECMO) before thrombolysis.
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At this point, mechanical ventilation was no longer sufficient to sustain oxygenation and venovenous ECMO (VV-ECMO) was commenced, as a bridge to urgent lung transplantation (Figure 1).
Transesophageal echocardiography (TEE) view with thrombus in left atrium before thrombolysis.
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TEE showed severely hypokinetic right and left ventricles along with a large thrombus in the left atrium near the pulmonary veins (Figure 2). The procedure was complicated by diffuse bleeding due to coagulopathy present in the septic state, which resulted in a 10 L blood loss.
Transesophageal echocardiography (TEE) view with no thrombus in left atrium after thrombolysis.
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TEE showed no thrombi in the left ventricle or pulmonary veins, although small thrombi remained in the right and left atria. The following day a full dose of thrombolytic agent was given - 50 mg alteplase over 2 hours intravenously - after which no further thrombi could be detected on TEE (Figure 3).
Chest X-rays, 1 week after thrombolysis.
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Lung function continued to improve along with radiological findings within 1 week following the thrombolysis (Figure 4).
Chest X-rays, 1 year following DLTx.. Abbreviation: DLTx, double-lung transplantation.
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Currently, she enjoys a good quality of life without any signs of stenosis of the upper respiratory tract and with stationary spirometric values (last forced expiratory volume in 1 second [FEV1] 38%) (Figure 5).