scholarly journals Case series of seven women with uterine fibroids associated with venous thromboembolism and chronic thromboembolic disease

2018 ◽  
Vol 9 (1) ◽  
pp. 204589401880387 ◽  
Author(s):  
Anne-Sophie Lacharite-Roberge ◽  
Farhan Raza ◽  
Riyaz Bashir ◽  
Chandra A. Dass ◽  
G. William Moser ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Venous Thromboembolism ◽  
Case Reports ◽  
Uterine Fibroids ◽  
Case Series ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Thromboembolic Disease ◽  
Pulmonary Thromboendarterectomy ◽  
Exertional Dyspnea ◽  
Chronic Thromboembolic Disease

Uterine fibroids have been described as an associate to acute venous thromboembolism (VTE), with case reports showing an association between large uterine fibroids, acute deep venous thrombosis (DVT), and acute pulmonary embolism (PE). However, there is little known about the association or causation between uterine fibroids, chronic thromboembolic disease (CTED), and chronic thromboembolic pulmonary hypertension (CTEPH). We report on six women with uterine fibroids and CTEPH, as well as one woman with CTED, all of whom presented with exertional dyspnea, lower extremity swelling, and in the cases of CTEPH, clinical, echocardiographic, and hemodynamic evidence of pulmonary hypertension and right heart failure. Compression of the pelvic veins by fibroids was directly observed with invasive venography or contrast-enhanced computed tomography in five cases. All seven women underwent pulmonary thromboendarterectomy (PTE) followed by marked improvement in functional, clinical, and hemodynamic status.

Chronic Thromboembolic Pulmonary Hypertension: When to Suspect It, When to Refer for Surgery

2003 ◽  
Vol 2 (1) ◽  
pp. 4-9 ◽  
Author(s):  
Kim M. Kerr ◽  
Peter F. Fedullo ◽  
William R. Auger
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Hypertension ◽  
Acute Pulmonary Embolism ◽  
Pulmonary Arteries ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
The United States ◽  
Thromboembolic Disease ◽  
Pulmonary Thromboendarterectomy ◽  
Thromboembolic Pulmonary Hypertension ◽  
Chronic Thromboembolic Disease

Chronic thromboembolic obstruction of the major pulmonary arteries is an underrecognized sequela of acute pulmonary embolism. Depending on the burden and location of thrombus, as well as on the duration of vessel obstruction, chronic thromboembolic disease may lead to pulmonary hypertension and cor pulmonale. Chronic thromboembolic disease affects an estimated 500 to 2500 patients each year in the United States, roughly 0.1 to 0.5 percent of patients who survive acute pulmonary embolism. Consequently, while this disease is uncommon, chronic thromboembolic pulmonary hypertension (CTEPH) is not rare, and should be considered in patients with unexplained dyspnea, as it is potentially correctible with pulmonary thromboendarterectomy.1

scholarly journals Balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic disease

2017 ◽  
Vol 8 (1) ◽  
pp. 204589321775312 ◽  
Author(s):  
Christoph B. Wiedenroth ◽  
Karen M. Olsson ◽  
Stefan Guth ◽  
Andreas Breithecker ◽  
Moritz Haas ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Arterial Compliance ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Functional Class ◽  
Thromboembolic Disease ◽  
World Health ◽  
Vascular Lesions ◽  
Walking Distance ◽  
Balloon Pulmonary Angioplasty ◽  
Chronic Thromboembolic Disease

Symptomatic patients with residual pulmonary perfusion defects or vascular lesions but no pulmonary hypertension at rest are diagnosed with chronic thromboembolic disease (CTED). Balloon pulmonary angioplasty (BPA) is an emerging treatment for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH), but data regarding the safety and efficacy of BPA in patients with CTED are lacking. We report a prospective series of ten consecutive patients with CTED who underwent 35 BPA interventions (median of four per patient) at two German institutions. All patients underwent a comprehensive diagnostic workup at baseline and 24 weeks after their last intervention. BPA was safe, with one pulmonary vascular injury and subsequent self-limiting pulmonary bleeding as the only complication (2.9% of the interventions, 10% of the patients). After the procedures, World Health Organization functional class, 6-min walking distance, pulmonary vascular resistance, and pulmonary arterial compliance improved, and NT-proBNP concentrations declined in 9/10 patients. BPA may be a new treatment option for carefully selected patients with CTED. A larger, prospective, international registry is required to confirm these results.

scholarly journals Surgical Treatment of Chronic Thromboembolic Pulmonary Hypertension

2007 ◽  
Vol 6 (2) ◽  
pp. 83-91
Author(s):  
Michael M. Madani ◽  
Stuart W. Jamieson
Keyword(s):  
Pulmonary Hypertension ◽  
Medical Management ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Thromboembolic Disease ◽  
Definitive Treatment ◽  
Pulmonary Vasculature ◽  
Pulmonary Thromboendarterectomy ◽  
Thromboembolic Pulmonary Hypertension ◽  
Long Term Prognosis

Pulmonary hypertension as the result of chronic pulmonary thromboembolic disease is a serious condition with poor long-term prognosis. The condition is one of the more common cardiovascular diseases affecting Americans, yet it is severely underdiagnosed. Pulmonary thromboendarterectomy is the definitive treatment for chronic pulmonary hyper-tension as the result of thromboembolic disease; however. it is an uncommon procedure, primarily because of lack of recognition on the part of the clinicians. Patients affected by chronic thromboembolic pulmonary hypertension (CTEPH) may present with a variety of debilitating cardiopulmonary symptoms. However, once diagnosed, there is no curative role for medical management, and surgery remains the only option. Palliation therapy with medical management in order to delay surgery carries the risk of prolonging the disease and irreversibly damaging unaffected pulmonary vasculature.

scholarly journals Surgical Treatment of Chronic Thromboembolic Pulmonary Hypertension

2000 ◽  
Vol 7 (1) ◽  
pp. 49-57 ◽  
Author(s):  
Fraser Rubens ◽  
Phil Wells ◽  
Steven Bencze ◽  
Michael Bourke
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiac Index ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Case Series ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Chronic Obstructive ◽  
Pulmonary Thromboendarterectomy ◽  
Case Series Study ◽  
Thromboembolic Pulmonary Hypertension

BACKGROUND:There are only limited treatment options for patients with chronic thromboembolic pulmonary hypertension in Canada.OBJECTIVE:To conduct a case-series study to assess the effectiveness of surgical endarterectomy of the pulmonary artery.DESIGN AND SETTING:Twenty-one patients with chronic thromboembolic pulmonary hypertension were admittedfor surgerybetween July 1995 and October 1999. Clinical, laboratory and radiological data were collected for all patients who then underwent pulmonary thromboendarterectomy.MAIN RESULTS:Thirteen men and eight women between 22 and 71 years of age underwent surgery. The main presenting complaint was dyspnea on exertion. Pulmonary vascular resistance ranged from 382 to 1694 dynes·s·cm-5with a mean of 765±372 dynes·s·cm-5(normal is less than 180 dynes·s·cm-5) with a mean cardiac index of 2.2±0.9 L/min/m2. Two patients had concomitant tricuspid valve replacement and one patient had coronary bypass grafting. In three cases, the surgery involved a repeat sternotomy. After surgery, there was a significant drop in the pulmonary vascular resistance (208±92 dynes·s·cm-5, P<0.05) and a concomitant rise in the cardiac index to a mean of 3.1±0.6 L/min/m2(P<0.05). There was one death in a patient who also had severe chronic obstructive pulmonary disease. Of the remaining patients, all but two showed significant clinical improvement. Spiral computed tomography postsurgery demonstrated improvement in pulmonary perfusion with either complete clearing or significant improvement in the mosaic perfusion pattern. Right ventricular function and pressure on echocardiogram improved in all but two patients.CONCLUSIONS:Pulmonary thromboendarterectomy provides effective treatment for chronic thromboembolic pulmonary hypertension.

P2771A novel doppler index for the diagnosis of post pulmonary embolism impairment syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
O Dzikowska-Diduch ◽  
M Kostrubiec ◽  
K Brodka ◽  
A Wyzgal-Chojecka ◽  
P Pacho ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Embolism ◽  
Pulmonary Hypertension ◽  
Ejection Fraction ◽  
Functional Limitation ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Thromboembolic Disease ◽  
Preserved Ejection Fraction ◽  
Thromboembolic Pulmonary Hypertension ◽  
Chronic Thromboembolic Disease

Abstract Introduction Follow-up studies demonstrated that after an episode of acute pulmonary embolism (PE), half of patients report functional limitation. Chronic thromboembolic pulmonary hypertension (CTEPH) is diagnosed in approximately 4%, while others are supposed to have heart failure with preserved ejection fraction (HFpEF) or chronic thromboembolic disease (CTED). Echo can not only assess tricuspidal regurgitation pressure gradient (TRPG) indicating pulmonary hypertension but also with tissue Doppler, E/e' ratio can diagnose left ventricular diastolic dysfunction. We tried to asses if a novel echo index: TRPG to E/e' could be useful in differentiation between CTEPH, CTED and HFpEF. Material and methods We analyzed data of consecutive 535 PE survivors (313 F, aged 61±17 yrs). 342/535 (64%) reported significant functional impairment after at least 6 months anticoagulation. All symptomatic subjects underwent detailed diagnostic workup which included standardized echocardiography, lung scintigraphy, pulmonary functional tests, and chest CT, RHC and coronary angiography when appropriate. Results Eventually, out of 342 symptomatic PE survivors (220 F, aged 65±15 yrs) CTEPH was diagnosed In 17 cases, CTED in 8 pts and HFpEF in 174 pts and in the remaining other causes were found (i.e. coronary artery disease, anemia, pulmonary disease). Doppler echocardiography showed that TRPG/E/e' was significantly increased in CTEPH and CTED patients when compared to subjects with HFpEF (Table 1). Echocardiographic doppler assessment HFpEF p CTEPH p CTED p n=174 HFpEF vs CTEPH n=17 CTEPH vs CTED n=8 HFpEF vs CTED TRPG (mmHg) 26.7±8.9 <0.01 59.5±32.0 0.013 34.4±15.1 ns E/e' 11.1±2.9 ns 10.1±32.0 ns 8.9±2.0 ns TRPG / E/e' 2.5±1.0 <0.001 6.0±2.4 <0.01 3.8±1.1 0.013 TRPG, Tricuspidal regurgitation pressure gradient; CTEPH, Chronic thromboembolic pulmonary hypertension; CTED, Chronic thromboembolic disease; HFpEF, Heart failure with preserved ejection fraction. Conclusion Our data indicate that echocardiographic index TRPG/(E/e') may be helpful in the differentiation of functional limitation in patients after pulmonary embolism.

scholarly journals Chronic Thromboembolic Disease and Chronic Thromboembolic Pulmonary Hypertension

2021 ◽  
Vol 42 (1) ◽  
pp. 81-90
Author(s):  
Irene M. Lang ◽  
Ioana A. Campean ◽  
Roela Sadushi-Kolici ◽  
Roza Badr-Eslam ◽  
Christian Gerges ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Thromboembolic Disease ◽  
Thromboembolic Pulmonary Hypertension ◽  
Chronic Thromboembolic Disease

Pulmonary Endarterectomy: Assessment of Operability, Surgical Description, and Post-op Care

2014 ◽  
Vol 12 (4) ◽  
pp. 186-192 ◽  
Author(s):  
David Poch ◽  
Victor Pretorius
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Pulmonary Arteries ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Pulmonary Artery Wedge Pressure ◽  
Pulmonary Endarterectomy ◽  
Pulmonary Thromboendarterectomy ◽  
Thromboembolic Pulmonary Hypertension ◽  
Wedge Pressure

Chronic thromboembolic pulmonary hypertension (CTEPH) is defined as a mean pulmonary artery pressure ≥25 mm Hg and pulmonary artery wedge pressure ≤15 mm Hg in the presence of occlusive thrombi within the pulmonary arteries. Surgical pulmonary thromboendarterectomy (PTE) is considered the best treatment option for CTEPH.

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