The definitive treatment of hemodynamically stable patients with pulmonary embolism and echocardiographically proven moderate to severe right ventricular dysfunction is unclear. We discuss the cases of a 45-year-old woman and a 62-year-old man that fulfilled the above criteria, but had a high risk for adverse events. Although both patients were treated according to current guidelines, one underwent successful surgical embolectomy the same day and the other was resuscitated a few days later. Surgery is an alternative for carefully selected patients with mild right ventricular dysfunction, but a high risk for adverse events that would otherwise be treated the same way as low- to moderate-risk patients.
Georg Thieme Verlag KG Stuttgart · New York.