Pulmonary Transplant Salvage Using Ultrasound-Assisted Thrombolysis of Subacute Occlusive Main Pulmonary Artery Embolus

2017 ◽  
Vol 12 (3) ◽  
pp. 214-216
Author(s):  
John R. Spratt ◽  
Prashant Shrestha ◽  
Gabriel Loor ◽  
Jagadish M. Patil ◽  
Marshall I. Hertz ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Main Pulmonary Artery ◽  
Lower Lobe ◽  
Left Main ◽  
Exertional Dyspnea ◽  
Bilateral Lung Transplantation ◽  
Catheter Directed Thrombolysis ◽  
Ultrasound Assisted ◽  
Bilateral Lung

A 53-year-old woman who underwent bilateral lung transplantation 14 months before presented with 2 to 3 weeks of severe exertional dyspnea. Workup revealed a complete embolic occlusion of her left main pulmonary artery related to a femoral deep venous thrombosis. The occlusion did not respond to systemic anticoagulation, and a trial of catheter-directed thrombolysis was pursued. Flow to the left lower lobe was restored after 2 days of thromobolytic therapy. The patient is alive and well at more than 1 year of follow-up.

Case 13.1

2014 ◽  
pp. 615-616
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Embolus ◽  
Main Pulmonary Artery ◽  
Lower Lobe ◽  
Left Lower Lobe ◽  
Shortness Of Breath ◽  
Left Main ◽  
Contrast Enhanced ◽  
Oblique Images

80-year-old man with a left lower lobe adenocarcinoma, for which he is receiving radiotherapy, presents with cough and shortness of breath; MRI was requested to evaluate for pulmonary embolus Coronal oblique images from 3D contrast-enhanced pulmonary MRA (Figure 13.1.1) reveal filling defects in the left main pulmonary artery and both lobar arteries....

scholarly journals Salvage endovascular embolization of the left pulmonary artery for recurrent pseudoaneurysm

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yojiro Yutaka ◽  
Junichi Tasaki ◽  
Itsuki Yuasa ◽  
Kotaro Murakami ◽  
Hiroshi Date
Keyword(s):  
High Risk ◽  
Pulmonary Artery ◽  
Lung Resection ◽  
Main Pulmonary Artery ◽  
Lower Lobe ◽  
Endovascular Embolization ◽  
Endovascular Coiling ◽  
Sleeve Resection ◽  
Left Main ◽  
Jude Medical

Abstract Background Pulmonary pseudoaneurysm (PPA) is a potentially lethal complication of lung resection with a high risk of recurrence after endovascular coiling. Case presentation We report a case in which recurrent hemoptysis due to PPA after left lower lobe sleeve resection was treated by endovascular embolization of the left main pulmonary artery as a salvage treatment. The first hemoptysis was managed by endovascular coil embolization with extracorporeal membrane oxygenation, but refractory hemorrhage occurred 3 months later due to penetration of the endovascular coil into the bronchial anastomosis site. Because left completion pneumonectomy was considered too high risk, the left main pulmonary artery was palliatively embolized using an Amplatzer vascular plug (St. Jude Medical, MN, USA) to totally disrupt the left pulmonary arterial flow. Conclusions Total embolization of the left main pulmonary artery for repeated PPA rupture may be useful as a palliative treatment in patients unable to tolerate pneumonectomy.

Cannulation of the Left Main Pulmonary Artery for Partial Left Heart Bypass

1979 ◽  
Vol 27 (3) ◽  
pp. 260-261 ◽  
Author(s):  
Stanley Giannelli ◽  
E. Foster Conklin ◽  
Robert T. Potter
Keyword(s):  
Pulmonary Artery ◽  
Main Pulmonary Artery ◽  
Left Heart ◽  
Left Main ◽  
Left Heart Bypass ◽  
Heart Bypass

Short- and Long-Term Outcomes of Catheter-Directed Thrombolysis versus Pulmonary Artery Embolectomy in Pulmonary Embolism: A National Population-Based Study

2021 ◽  
pp. 152660282110547
Author(s):  
Donna Shu-Han Lin ◽  
Yu-Sheng Lin ◽  
Jen-Kuang Lee ◽  
Wen-Jone Chen
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Hazard Ratio ◽  
Hospital Death ◽  
Research Database ◽  
Old Patients ◽  
Catheter Directed Thrombolysis ◽  
All Cause Mortality

Objectives: This study aimed to compare the short-term and long-term follow-up outcomes of catheter-directed thrombolysis (CDT) with those of pulmonary artery embolectomy (PAE) for patients with acute pulmonary embolism (PE) included in a nationwide cohort. Background: Data allowing direct comparisons between CDT and PAE are lacking in the literature, and the optimal management of high-risk and intermediate-risk PE is still debated. Methods: A retrospective cohort study was conducted with data for 2001 through 2013 collected from the Taiwan National Health Insurance Research Database (NHIRD). Patients who were first admitted for PE and treated with either CDT or PAE were included and compared. In-hospital outcomes included in-hospital death and safety (bleeding and cardiac arrhythmias) outcomes. Follow-up outcomes included all-cause mortality and recurrent PE during the 1- and 2-year follow-up periods and through the last follow-up. Inverse probability of treatment weighting (IPTW) based on the propensity score was used to minimize possible selection bias, including indices for multimorbidity such as the Charlson’s Comorbidity Index (CCI) and HAS-BLED scores. Results: A total of 389 patients treated between January 1, 2001, and December 31, 2013, were identified; 169 underwent CDT and 220 underwent PAE. After IPTW, there were no significant differences in in-hospital mortality (18.2% vs 21.3%; odds ratio 1.07, 95% confidence interval [CI]: 0.70–1.62) or the incidence of safety outcomes between the CDT and PAE groups. The risks of all-cause mortality (30% vs 29.5%; hazard ratio 1.16, 95% CI: 0.89–1.53), recurrent PE (7.2% vs 8.7%; subdistribution hazard ratio [SHR] 0.68, 95% CI: 0.39–1.21) and new-onset pulmonary hypertension (SHR 0.25, 95% CI: 0.05–1.32) were also not significantly different between the CDT and PAE groups at 2 years of follow-up. Subgroup analysis indicated that PAE may be associated with a more favorable 2-year mortality in patients <65 years old, patients with CCI scores of <3, patients with HAS-BLED scores of 1 to 2, and patients without cardiogenic shock (all P for interaction <.05). Conclusions: In patients with PE who required reperfusion therapy, CDT and PAE resulted in similar in-hospital and long-term all-cause mortality rates and long-term rates of recurrent PE. Bleeding risks were also comparable in the 2 groups.

Abstract 523: Ultrasound Assisted Thrombolysis Versus Catheter Directed Thrombolysis: A Meta-Analysis

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
Syed Imran M Zaidi ◽  
Abdul Ahad Khan ◽  
Hemang B Panchal ◽  
Zulfiqar Qutrio Baloch ◽  
Enambir Josan ◽  
...  
Keyword(s):  
Success Rate ◽  
Meta Analysis ◽  
Ultrasonic Energy ◽  
Short Term ◽  
Bleeding Events ◽  
Thrombolytic Agents ◽  
Catheter Directed Thrombolysis ◽  
Pubmed Database ◽  
Ultrasound Assisted

Introduction: Deep venous thrombosis (DVT) and pulmonary embolism (PE) have many methods of treatment including anti-coagulation, thrombectomy and thrombolysis. Thrombolysis can be achieved via systemic or local thrombolytic agents, with standard local thrombolysis achieved via catheter insertion in proximity to the thrombus and delivery of thrombolytic agents. Ultrasound-assisted catheter thrombolysis (UAT) is a relatively newer form of thrombolysis which utilizes ultrasonic energy, along with local thrombolytics to help in thrombus breakdown. The objective of our meta-analysis is to compare UAT and catheter directed thrombolysis (CDT) for treatment of DVT and PE. Methods: PubMed database was searched through January 2017. Three studies (n=156) comparing UAT (n=99) and CDT (n=57) for thrombolysis were included. End points were > 50% thrombus lysis, bleeding (moderate and severe), and mortality on short term follow up (<1 year). The relative risk (RR) or mean difference (MD) with 95% confidence interval (CI) was computed and p<0.05 was considered as a level of significance. Results: Thrombolysis success rate was similar with UAT and CDT (RR 1.06, CI 0.89-1.27, p=0.49). Moderate and severe bleeding events were similar with both groups (RR 0.71, CI 0.27-1.87, p=0.49). Mortality on short term follow up was significantly lower in UAT as compared to CDT (RR 0.47, CI 0.23-0.95, p=0.04). Conclusions: The results of our meta-analysis demonstrated no difference in thrombolysis success rate or bleeding events when using UAT Vs CDT, however short term mortality was significantly lower with UAT. Further controlled trials with larger sample sizes are required to assess the possible benefit of using ultrasonic energy for venous thrombolysis.

Atrial septal defect causing angina

2019 ◽  
Vol 27 (7) ◽  
pp. 593-596
Author(s):  
Dhananjay Bansal ◽  
Mohd Javed Banday ◽  
Anubhav Gupta ◽  
Palash Aiyer ◽  
Vijay Grover ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Atrial Septal Defect ◽  
Left Coronary Artery ◽  
Septal Defect ◽  
Left Main Coronary Artery ◽  
Artery Bypass ◽  
Main Pulmonary Artery ◽  
Left Main ◽  
Patch Closure

Left coronary artery compression syndrome is characterized by compression of the left main coronary artery between the aorta and an enlarged main pulmonary artery. A 39-year-old woman presented with angina with dyspnea on exertion for two years. Detailed investigations revealed an atrial septal defect, valvular lesions, and severe pulmonary hypertension with left main coronary artery compression. Patch closure of the atrial septal defect, left coronary artery bypass, and valve repair was carried out. The patient recovered well and was asymptomatic on follow-up. The optimal management of such patients is yet to be clarified.

scholarly journals Successful sparing approach between the ascending aorta and the main pulmonary artery to the giant coronary aneurysm of the left main coronary artery

2020 ◽  
Vol 13 (4) ◽  
pp. e234203
Author(s):  
Ken Nakamura ◽  
Kouan Orii ◽  
Takayuki Abe ◽  
Hirofumi Haida
Keyword(s):  
Coronary Artery ◽  
Pulmonary Artery ◽  
Left Main Coronary Artery ◽  
Main Pulmonary Artery ◽  
Coronary Aneurysm ◽  
Ascending Aorta ◽  
Left Main ◽  
Giant Coronary Aneurysm

Coronary aneurysm located just above the left main coronary artery (LMT) is rare and difficult to treat. How the aneurysm is accessed is very important as it determines the result of the surgery. A 70-year-old man with a large coronary aneurysm (40 mm in diameter) in the LMT underwent surgery to prevent its rupture; however, there was severe adhesion. Initially, dissection of the ascending aorta or the pulmonary artery seemed necessary to access the aneurysm; however, the process was possible with limited dissection between the ascending aorta and the pulmonary artery, and we succeeded in firmly closing the LMT site of entry.

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