United Arab Emirates, Dubai, July 19, 2018:  There were several complications along the way and time was not on their hands, but the multidisciplinary team at Rashid Hospital successfully carried out the first pulmonary embolism catheter directed clot lysis procedure in Dubai saving the life of a 64-year-old Arab expatriate.

Pulmonary embolism is a life-threatening condition that is caused by blood clots that travel from the legs to the lungs and block the blood flow to the lungs. 

Dr Shibu Bahuleyan, Cardiologist at Rashid Hospital said, “The patient was brought into the emergency department with complaints of drowsiness and weakness. His blood pressure was very low, so we immediately started IV fluids to keep him stable. We also conducted a battery of tests including an ECG and chest X-ray. 

“The two most common causes of such low blood pressure can be a heart attack or a serious infection in the body, however, the tests we conducted ruled out both these conditions. The ECG pointed out that there was a strain on the right side of the heart.”

Dr Bahuleyan added, “We also conducted a D-timer test which was elevated and that provided a clue to a possible pulmonary embolism. A CT pulmonary angiogram confirmed this and revealed a huge clot, blocking almost 90 to 95 per cent of the arteries in both lungs. The angiogram also revealed that the clot had caused failure of the right side of the heart.”

Considering the seriousness of the medical condition, a multidisciplinary team was immediately put together. 

Dr Ayman Al Sibai, Interventional Radiologist at Rashid Hospital said, “Usually such patients are treated with anticoagulants (blood thinners) and fibrinolytics (clot dissolving drugs); however, in some cases internal bleeding is the main complication of clot dissolving drugs. This patient had a low platelet count, which is a major risk factor for internal bleeding; so we had to opt for another procedure.”

Dr Al Sibai said, “We went ahead with catheter directed therapy. We introduced a catheter in the blood vessels of the lungs and attempted to suck out the clots. This was partially successful because of the large size and thickness of the clots. We then infused very small doses of the clot dissolving medication in the catheter and targeted the exact spots. We kept the catheter in the patient for 36 hours ensuring a very low and slow release of the clot dissolving medication. Over the course of time, the blood clots began to dissolve and the patient’s blood pressure and oxygenation started improving.”

Dr. Bahuleyan said the patient remained in the cardiology CCU during this duration.  “The patient was kept under observation for another week and then discharged.”

Dr Al Sibai said, “Very few countries in the West and few places like India have performed such a procedure before. In Dubai it was the first time such as procedure was performed.”

The team consisted of Dr. Salman Abdel Aziz, Consultant Internal Medicine; cardiologists Dr. Khalifa Omar and Dr. Shibu Bahuleyan, Dr Ayman Al Sibai, Interventional Radiologist, experts form internal medicine, cardiology, interventional radiology, and a backup team of cardiothoracic surgeons.