scholarly journals Management of Pulmonary Embolism with Rheolytic Thrombectomy

2011 ◽  
Vol 18 (4) ◽  
pp. e52-e58 ◽  
Author(s):  
Lisa Ferrigno ◽  
Robert Bloch ◽  
Judson Threlkeld ◽  
Thomas Demlow ◽  
Raman Kansal ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Pulmonary Artery Pressure ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Shock Index ◽  
Pulmonary Embolectomy ◽  
Artery Pressure ◽  
Rheolytic Thrombectomy

BACKGROUND: Catheter thrombectomy combining thrombus destruction with local thrombolysis has been used in patients with pulmonary embolism (PE) who are unstable or have significant right heart dysfunction, but have contraindications to systemic thrombolytic therapy.OBJECTIVES: To assess the outcomes of patients who underwent pulmonary embolectomy using a commercially available thrombectomy device.METHODS: A retrospective chart review of patients who underwent pulmonary embolectomy between March 2007 and August 2009 was performed. Patients were classified as having clinical massive or submassive PE, and moderate or severe right ventricular dysfunction. Data collected included pre- and postprocedure shock index (heart rate divided by systolic blood pressure) and mean pulmonary artery pressure.RESULTS: Sixteen patients with a mean (± SD) age of 54.4±15.8 years underwent embolectomy. Five had clinical massive PE (two in cardiogenic shock) and three of 11 submassive cases had severe right ventricular dysfunction. All were deemed to have contraindications to systemic lysis. Both shock index (1.02±33 preintervention versus 0.71±0.2 postintervention [P=0.001]) and mean pulmonary artery pressure (34.5±9.9 mmHg preintervention versus 27.1±7.1 postintervention [P=0.01]) improved. In the massive PE group, one patient died and two survivors experienced retroperitoneal bleeding and transient renal failure. At follow-up (17.3±7.8 months), two patients in the massive PE group demonstrated evidence of mild cor pulmonale.CONCLUSION: Rheolytic thrombectomy is an effective strategy in managing massive PE, particularly in patients who have well-defined contraindications to systemic lytic therapy. The effectiveness of rheolytic thrombectomy for submassive PE is not as well defined, but warrants a comparison with systemic lytic therapy.

CHANGES IN THE LEVEL OF NT-proBNP AND MEAN PULMONARY ARTERY PRESSURE FOLLOWING BRONCHOPLASTIC LOBECTOMY OR PNEUMONECTOMY AS MARKERS OF RIGHT VENTRICULAR DYSFUNCTION

2021 ◽  
pp. 6-13
Author(s):  
V. F. Larin ◽  
V. A. Zhikharev ◽  
A. S. Bushuev ◽  
V. A. Porhanov ◽  
V. A. Koriachkin ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Pulmonary Artery Pressure ◽  
Pulmonary Resection ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Control Group ◽  
Artery Pressure ◽  
The Mean

Background There are scanty data of right ventricular dysfunction markers after major pulmonary resection.Objective To study the changes of plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) and its association with pulmonary artery pressure (PAP) as markers of right ventricular dysfunction in patients who underwent bronchoplastic lobectomy or pneumonectomy.Material and Methods The study population consisted of 36 patients aged 40–65 who underwent major  pulmonary resection for lung cancer in 2016–2018. Patients were stratified into two groups according to the type of surgical procedure: bronchoplastic lobectomy, the main group (n = 19), and pneumonectomy, control group (n = 17). They were then analyzed for plasma NT-proBNP concentration, operative time, blood loss, intraoperative fluid administration, intraoperative urine output, and mean PAP level before and after an operation.Results The mean PAP level correlated positively with the plasma NT-proBNP concentration in the pneumonectomy group (Pearson r = 0.916754; p < 0.001). This correlation was no evident in the subset of patients undergoing bronchoplastic lobectomy at the same determination point (Pearson r = 0.234741; p = 0.330).Conclusion The mean PAP increased significantly after pneumonectomy and is closely correlated with plasma  NTproBNP concentration. These findings support the conclusion that bronchoplasty is preferable over pneumonectomy for lung cancer patients.

scholarly journals Severe Pulmonary Hypertension in Acute Pulmonary Thromboembolism: More Common than Expected?

2020 ◽  
Author(s):  
Mahsa Behnemoon ◽  
Elham Laleh ◽  
Amin Sedokani ◽  
Ayatay Bahrami
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Hospital Mortality ◽  
Right Ventricular ◽  
Pulmonary Artery Pressure ◽  
Severe Pulmonary Hypertension ◽  
Artery Pressure ◽  
Acute Pe ◽  
Echocardiographic Findings

Abstract Background: Pulmonary embolism (PE) is a relatively common health problem and the third most common cause of cardiovascular death with a 15-20 percent mortality rate. Severe pulmonary arterial hypertension is not common in acute forms of the disease, and we usually expect only mild to moderate degrees of PAH in these patients. However, we have encountered numerous cases of severe pulmonary hypertension after acute PE in our practice. In this study, we aimed to evaluate the echocardiographic findings of patients admitted with documented PE in a 5 years study of two heart centers of Urmia.Methods: In this retrospective study, the data of 183 patients with a definitive diagnosis of acute pulmonary embolism based on pulmonary CT angiography have entered the study.Results: Of the 183 cases diagnosed with pulmonary embolism with an average age of 61.15 years, 45.4% were male and 54.6% were female. Shortness of breath, chest pain, and hemoptysis were seen in 88%, 49.2%, and 13.1% of patients, respectively. Tachypnea and tachycardia were the most common clinical findings with a frequency of 54.1%. Echocardiographic findings of right ventricular enlargement and right ventricular dysfunction were observed in 66.7% and 67.8% of patients, respectively and 42.1% of patients had severe pulmonary hypertension. We found a significant relationship between pulmonary artery pressure severity and shock state as well as in-hospital mortality. While only 3 patients out of 64 cases (4%) with normal or mildly elevated pulmonary artery pressure died in their hospital stay period, the mortality rate was 28.5% in patients with moderate or severe pulmonary artery hypertension (p-value=0.002).Conclusion: we found a relatively high frequency of severe pulmonary artery hypertension in patients admitted with the definite diagnosis of acute pulmonary embolism and there was a significant correlation between pulmonary artery pressure severity and shock state, as well as in-hospital mortality. So, echocardiographic findings including right ventricular systolic pressure and TR velocity may have additional prognostic value in the decision making of acute PE patients and could be helpful in reducing in-hospital mortality of this complex illness provided being included in prognostic models of acute PE, based on future studies.

scholarly journals Pulmonary hypertension or cardiology aerobatics

2020 ◽  
Vol 17 (2) ◽  
pp. 66-68
Author(s):  
I. E. Chazova ◽  
T. V. Martynyuk ◽  
N. M. Danilov
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Pulmonary Vascular Resistance ◽  
Pulmonary Artery Pressure ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Progressive Increase ◽  
Hemodynamic Pattern

Pulmonary hypertension (PH) is a group of diseases with a hemodynamic pattern of progressive increase in pulmonary vascular resistance (PVR) and pulmonary artery pressure (PAP), which leads to right ventricular dysfunction and the development of right ventricular heart failure.

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