Aim. The demonstration of a case of successful treatment of a massive pulmonary thromboembolism (PTE) in the female patient of 42 y.o. with hyperhomocysteinemia, long contraceptives and thyroid hormones use. 7 days later the case was complicated by acute respiratory failure and cardiogenic shock. Treatment require the artificial ventilation of the lungs, systemic thrombolysis and the subsequent thrombectomy in the conditions of an artificial circulation.
Methods. PTE was at first suspected clinically (a dyspnea at small loads, tachycardia) and then confirmed with 8 times rising of the D-dimer level, lung perfusion scan withTc99m-MAA (defects in right and basal departments left lung), ultrasound pressure in the pulmonary artery (PA) to 44 mm of mercury. 7 days later - a sudden loss of consciousness, shock. The large mobile thrombus (Echocardiography) was in the right auricle, pressure in LA of 79 mm of mercury was found. The emergency thrombectomy from a pulmonary trunk and pulmonary arteries was urgently executed in the conditions of an artificial circulation, the kava-filter is installed later.
Results. 3 years later our patient stable, PTE - without recurrence. Treatment - Rivaroxaban, Angiovit (vitamins B6, B9, B12). The thyroxine and estrogen-containing contraceptives were cancelled. Level of a homocystein and pressure in LA are normal.
Conclusions. Estrogen-containing contraceptives and genetic thrombophilia (including hyperhomocysteinemia) are common PTE risk factors in young women. PTE is a preventable hospital lethality and maternal mortality leader in the developed countries now. Modern scales of risk factors, algorithms of prophylaxis, diagnostics and treatment of PTE are discussed in the report.