Dynamic ECG changes after thromboendarterectomy in a patient with chronic thromboembolic pulmonary hypertension and C protein deficiency

A case of a 44-year-old-man with chronic thromboembolic pulmonary hypertension (PH) and C-protein deficiency, with a history of previous acute pulmonary embolism is presented. The ECG showed negative T waves in leads: II, III, aVF and V 1 –V 6 . The follow-up echocardiography revealed severe PH with the right ventricular systolic pressure (RVSP) — 95–100 mm Hg, markedly enlarged right ventricular end-diastolic diameter (RVEDD), and decreased left ventricular end-diastolic diameter (LVEDD). The patient was in NYHA III/IV class. He was referred for pulmonary thromboendarterectomy. Three months after thromboendarterectomy echocardiography showed marked reduction of RVEDD, increased LVEDD, RVSP — 50–55 mm Hg. The 3 months follow-up ECG showed normalisation to positive T waves. The patient was in NYHA class I and he stayed on the anticoagulation therapy.