dr pankaj goel: Case of the Month- Pulmonary Embolism Masquerading As Acute Decompensation In A Patient With Severe Aortic Stenosis.

Profile

Dr Pankaj Goel, is currently working as a Director and Head of the Cardio-thoracic and Vascular (Heart, Lung and Vascular Surgery) unit at the Ivy Hospital, Amritsar.

After completing his MCh in cardio-thoracic and vascular surgery from GB Pant Hospital, Delhi University in 1998, Dr Goel worked at Madras Medical Mission, Chennai for three years. Here he obtained training in complex paediatric cases. Thereafter he went to Australia (Royal Perth Hospital) for further training and experience.

Dr Goel joined the Fortis Escorts Hospital, Amritsar in 2003. Since 2008 , in his capacity as HOD at the same hospital he has done pioneering work and established cardio-thoracic and vascular surgery in the city.

The Goel's unit now routinely performs all types of cardiac, thoracic and vascular surgeries with results comparable to the best centres in the world. Dr Goel is responsible for many firsts in the region.

Dr Goel has several research papers published in indexed journals. He has authored a book on cardiac surgery. He has an original technique for harvesting saphenous vein to his credit.

In 2009, Dr Goel was elected member of the prestigious Society of Thoracic Surgeons , USA. He is also a member of the Indian Association of Cardio-thoracic surgery and CTS Net.

At Ivy Hospital, Dr Goel routinely performs all types of Cardiac, thoracic (including thoracoscopic) and vascular procedures.

Wednesday 30 January 2013

Case of the Month- Pulmonary Embolism Masquerading As Acute Decompensation In A Patient With Severe Aortic Stenosis.

A 58-year-old gentleman with known aortic stenosis, presented with acute onset of New York Heart Association Class IV dyspnoea and bi-ventricular failure. His transthoracic echo revealed severe calcific aortic stenosis, severe pulmonary arterial hypertension with severe bi-ventricular dysfunction. There was also a large mobile mass in the right atrium projecting into right ventricle the presence of which was confirmed on trans-esophageal echocardiography (Fig.1).

The patient was taken up for urgent surgery. Per-operatively, a linear clot, measuring eighteen centimeters was found in the right atrium (Fig.2). It was extending through the tricuspid valve into the right ventricle. The clot was removed. A small patent foramen ovale was present which was closed directly. Aortotomy was then performed and aortic valve replacement was done with a mechanical valve.

After the patient was shifted to ICU, a peripheral venous Doppler revealed bilateral deep vein thrombosis extending into femoral veins. An inferior vena caval filter was deployed.

The patient was discharged on oral anticoagulation.

This case demonstrates that in patients with pre-existing heart disease who present with sudden de-compensation, acute pulmonary embolism should also be considered and investigated for.

Figure1.