Pulmonary Thromboendarterectomy in a Known Case of Antiphospholipid Syndrome

Abstract

A 23-year-old male was admitted to our hospital with complaints of shortness of breath, grade-III, chest pain, and palpitation for the last 3 months. He had one episode of hemoptysis 3 months back. He was a known case of primary antiphospholipid antibody syndrome (APS) with bilateral chronic pulmonary thromboembolism with chronic thromboembolic pulmonary hypertension (CTEPH) with the presence of anticardiolipin antibody. The patient had no history of joint pain, hematuria, and photosensitivity. He was on domiciliary oxygen therapy at 1 L/min to maintain an oxygen saturation of 93%, riociguat, ecosprin, hydroxychlor-oquine, and enoxaparin. The patient was referred to our hospital for pulmonary thromboendarterectomy (PTE). On investigation, his two-dimensional (2D) echocardio-gram showed global left ventricular hypokinesia with an ejection fraction of 25%, severe right ventricular systolic dysfunction, dilated right atrium and ventricle, dilated tricuspid valve annulus with severe tricuspid regurgitation, mild pulmonary regurgitation, high normal inferior vena cava with an absence of respiratory collapse, and pulmonary artery systolic pressure of 37mm Hg.