Chapters Transcript Video Managing High-Risk Pulmonary Embolism With Clot in Transit: A Multidisciplinary Approach My name is Tatiana Castillo. I'm 76 years old. I have 3 daughters. I'm a dental hygienist. I love gardening and animals. When I got sick in um in January, I started with uh influenza A. The coughing came right away, a lot of coughing. Um, and very tired when I almost fainted, uh, coming from the bathroom to the bed, then I told my daughter tomorrow take me to the Baptist emergency room. Tatiana presented to the hospital with severe shortness of breath. She had some chest pain and she had a near syncopal episode, meaning that she had almost passed out. These symptoms are non-specific and there's a lot of diseases which could. Potentially cause the same symptoms, but in her case, she had something known as a pulmonary embolism, a very significant pulmonary embolism, which was causing strain on her heart and it was preventing her heart from adequately pumping blood to her lungs. I have heard, of course, of a pulmonary embolism. But I never looked into it, so I did, I didn't recognize the symptoms. A pulmonary embolism is simply a clot or blood clot in the arteries which are feeding the lungs, the pulmonary arteries. They typically arise from a clot in the leg, which ultimately. Ends up breaking off and goes through the heart and into the pulmonary artery. In fact, pulmonary embolism is the 3rd leading cause of cardiovascular mortality in the hospital and across the United States. Dr. Gandhi was very helpful. Um, he put me at ease. He explained everything to me before the procedure, and he reassured me everything's gonna be fine. You know, we typically diagnose pulmonary embolism with a CT pulmonary angiogram, but in her situation, we also did an echocardiogram, which revealed that there was something known as a clot in transit. Uh, which is essentially a clot which is sitting in the heart, so if that were to break off, that could put her into sudden cardiac arrest and that could end up being a fatal event. What happened to me was very shocking for me. I hardly get sick. I, I don't even catch colds and I've never had a blood clot. And we activated the pulmonary embolism response team. And given that there was a large clot in transit, in that situation, we utilize something called ECMO. We collaborated with Dr. Wen and his team. ECMO is essentially a machine that supports the patient's heart and lungs. During the patient's procedure, there's a possibility that she might become unstable, either removing the clot while removing the clot or having more clot formation. So in the event that the patient became unstable, we would put the patient on ECMO and support the patient's heart and lungs while the procedure could be performed. If the patient became unstable and we didn't do ECMO, then the patient could die. So the procedure went very, very smoothly. We utilized a newer device which is basically a device utilized to remove or aspirate clot. Then we put the device into the pulmonary arteries to remove. And at that point in time, her blood pressure dropped and we were ready at that point in time to start the ECMO, but we removed a large amount of clot immediately and we did not have to place her on ECMO. Having ECMO really allows us to push the envelope and take care of the sickest of the sick. A lot of institutions have ECMO, but not all institutions have immediate access to ECMO. And it's important because some patients might crash or become unstable, and having access in a timely fashion could be life saving. And she did very, very well from the procedure. The procedure probably took maybe an hour, and this was again someone who was on death's door. You know, some studies quote about 30% risk of death, and we went and we took her from that to basically. Normal vital signs after the procedure. Dr. Gandhi showed me the blood clots. There were a lot of them after they removed the blood clots that I felt right away a relief in my lungs. I could breathe like very easily. It was amazing. Here at Baptist Health Miami Cardiac and Vascular Institute, we manage hundreds of patients with pulmonary embolism each year. And our outcomes are typically excellent and that's really the result of our multidisciplinary team of physicians excellent experience of our physicians, us being at the leading edge of clinical research. I really feel that Baptist Health Miami Cardiac and Vascular Institute is a very, very efficient and. Wonderful practice they treated me excellent and the doctors are very nice and I feel very grateful that I'm alive. I almost died. I look forward to enjoying my life because I feel great. Created by
