An unconventional approach to polymorbidity yielded excellent results for a young cancer patient

Thanks to the expert knowledge and skills of specialists, modern equipment and multidisciplinary approach, the high-tech hospital complex ‘Heart and Brain’ in Burgas provides comprehensive care for patients from all over Southeastern Bulgaria

A young patient with abdominal bloating is admitted to the gastroenterology clinic of Heart and Brain Hospital in Burgas. From the examinations carried out – scanner and endoscopy, the doctors found a particular form of oncological disease affecting the stomach, namely non-cohesive carcinoma. At the time of diagnosis the cancer was at an advanced stage, unsuitable for surgery. The doctors immediately sent all the tests for an opinion from an oncology committee.

Two days later, on the eve of May 24, the patient suddenly became short of breath and had palpitations. The cardiology specialists at ‘Heart and Brain’ determined that it was pulmonary thromboembolism, the second leading cause of sudden death after heart attack. A scan confirmed massive bilateral pulmonary thromboembolism.

Given the patient’s condition and the newly diagnosed gastric carcinoma, the invasive cardiologists undertake fragmentation and thrombus extraction (breaking up and removing) of the massive amount of thrombi over a two-hour period. The entire procedure takes place without any blood loss, and the aspirated blood is filtered and returned to the patient’s body. During the procedure, the source of the pulmonary thromboembolism is also identified, namely a venous thrombosis in the patient’s abdomen. Given the location and presence of residual venous thrombosis, an empty vein filter is also implanted to protect the patient from a life-threatening recurrence of pulmonary thromboembolism. The entire vein cava filter extraction, fragmentation and implantation procedure is painlessly performed completely bloodlessly and percutaneously and the patient is fully conscious.

Due to the contraindications and polymorbidity in the young patient, the specialists cannot apply fibrinolytic therapy, which is the gold standard. Therefore, the physicians undertook an unconventional multidisciplinary approach that combined the capabilities of the cardiologists, cardiac surgeons and vascular surgeons teams, and yielded an excellent outcome for the young man.