Chronic Thromboembolic Pulmonary Hypertension after Pulmonary Embolism, Thrombolysis, Catheter Fragmentation, and Embolectomy

A 21-year-old male patient (marathon runner) with progressive dyspneaover8weekswas admitted tohospital onanemergency basis. The initial examination at admission revealed cardiopul-monary dysfunction with normal blood pressure, tachycardia (112 bpm) andhypoxia (pO2 50.1 mmHg), and an elevation of D-dimeres (5.5 mg/L). Echocardiography, chest computed tomo-graphic scan, and a duplex sonography of the lower extremity veins showed a massive, bilateral pulmonary embolism with right ventricular dysfunction (right ventricular systolic pressure: 90 mm Hg) and a concomitant popliteal vein thrombosis. Screening for thrombophilia was negative. The patient was treated systemically with heparin and 120 mg of recombinant tissue plasminogen activator (rt-PA), that is, recombinant tissue plasminogen activator (Alteplase) intravenously followed by catheter-based thrombus fragmen