In Reply to: Re: Case 0400_04 -- The Safety of Pulmonary Angiography in Patients with Severe Pulmonary Hypertension posted by Grant Price on April 07, 2000 at 09:00:14:
I am presenting a single case of a death following Pulm. art. angiogram. The pt. was a 44 yr old male, examined and released 4 days earlier at another hospital who presented in severe respiratory distress. VQ was indeterminate and quoted as more consistant with COPD ( though history did not match). Pulm. angio was requested due to high clinical suspician, pO2 of 150 on 100%O2, and the intent if positive to start thrombolytics.
Echo did support right ventricular dilation
Due to pt's condition and a delay in obtaining pressure equipment, Pulmonary angio of left PA only was performed in 2 views which supported acute PE and procedure terminated after diagnosis. Pressure finally obtained quickly after angio 70/20.
Within 5 minutes after catheter removal, the pt. went into bradycardia followed by cardiac arrest and expired following unsuccessful code of 40 minutes.
Though it is difficult to say if pt. would have survived this massive PE without Pulm. angio, in retrospect, the pt. should have been intubated prior in his condition. With a 2-3% mortality quoted from pioped with these higher pressures, I still would have performed the Pulm. angio in this case, feeling the dx was worth the risk. In retrospect, a good contrast chest CT earlier may have given the dx in a prompt enough time to have started and successfully treated with thrombolytics.