scholarly journals ENDOVASCULAR TREATMENT OF THE RESIDUAL THROMBOEMBOLIC PULMONARY HYPERTENSION AFTER PULMONARY THROMBENDARTERECTOMY WITH THE DENERVATION SYSTEM SYMPLICITY

2018 ◽  
Vol 17 (2) ◽  
pp. 43-48 ◽  
Author(s):  
B. A. Rudenko ◽  
D. A. Feshchenko ◽  
A. S. Shanoian ◽  
О. М. Drapkina ◽  
N. Е. Gavrilova ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Exercise Tolerance ◽  
Time Interval ◽  
Radiofrequency Denervation ◽  
Clinical Benefits ◽  
Thromboembolic Pulmonary Hypertension ◽  
The Right ◽  
Mean Time

Aim. To assess the safety and efficacy of radiofrequency denervation of pulmonary artery (PA) with the Simplicity system in patients with residual pulmonary hypertension (PH) after the thromberarterectomy surgery.Material and methods. To the study, 12 patients included, with the signs of residual PH (by echocardiography data, mean PH pressure ≥25 mmHg), who had undergone surgery (thrombendarcterectomy) for chronic thromboembolic PH. Mean time interval between the diagnosis of PH and pulmonary denervation was 8,5 years. After catheterization of the right chambers of the heart and tensiometry in small circle circulation, the spot circular radiofrequency denervation performed of the right and left PH at the area of ostia, with ablation catheter Simplicity. The success was defined by decrease of mean PA pressure >10 mmHg, absence of complications, exercise tolerance increase after the procedure immediately and in 12 months.Results. At long term period after the intervention there was significant decrease of mean PA pressure from 58±6 to 33±4 mmHg (p<0,01), of pulmonary vascular pressure from 8,6±2,1 to 3,2±1,4 mmHg (p<0,01) and increase of exercise tolerance from 321±19 m to 487±29 m (p<0,01). During the follow up period, 1 patient died in 8 months after inclusion due to severe gastrointestinal bleeding. The rest did not present with adverse events or non­planned hospitalizations. Nine patients noted significant improvement of general health, decrease of dyspnea and fatigue, 3 patients had discontinued sildenafil. There were no complications at PA radiofrequency ablation procedure (death, arrhythmias, PA perforation, acute PA thrombosis in the place of access, bleeding).Conclusion. Utilization of the Simplicity system in PA denervation is safe and effective. Further randomized studies in need to confirm clinical benefits from the procedures in PH patients.

scholarly journals Long-Term Imaging Follow-Up in DIPNECH: Multicenter Experience

2021 ◽  
Vol 10 (13) ◽  
pp. 2950
Author(s):  
Cécile Chung ◽  
Sébastien Bommart ◽  
Sylvain Marchand-Adam ◽  
Mathieu Lederlin ◽  
Ludovic Fournel ◽  
...  
Keyword(s):  
Distant Metastases ◽  
Female Gender ◽  
Invasive Disease ◽  
Metastatic Spread ◽  
Time Interval ◽  
Cell Hyperplasia ◽  
Mean Time ◽  
Pulmonary Neuroendocrine Cell

Diffuse pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare pre-invasive disease whose pathophysiology remains unclear. We aimed to assess long-term evolution in imaging of DIPNECH, in order to propose follow-up recommendations. Patients with histologically confirmed DIPNECH from four centers, evaluated between 2001 and 2020, were enrolled if they had at least two available chest computed tomography (CT) exams performed at least 24 months apart. CT exams were analyzed for the presence and the evolution of DIPNECH-related CT findings. Twenty-seven patients, mostly of female gender (n = 25/27; 93%) were included. Longitudinal follow-up over a median 63-month duration (IQR: 31–80 months) demonstrated an increase in the size of lung nodules in 19 patients (19/27, 70%) and the occurrence of metastatic spread in three patients (3/27, 11%). The metastatic spread was limited to mediastinal lymph nodes in one patient, whereas the other two patients had both lymph node and distant metastases. The mean time interval between baseline CT scan and metastatic spread was 70 months (14, 74 and 123 months). Therefore, long-term annual imaging follow-up of DIPNECH might be appropriate to encompass the heterogeneous longitudinal behavior of this disease.

scholarly journals Exercise tolerance and quality of life in hemodynamically partially improved patients with chronic thromboembolic pulmonary hypertension treated with balloon pulmonary angioplasty

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0255180
Author(s):  
Kotaro Miura ◽  
Yoshinori Katsumata ◽  
Takashi Kawakami ◽  
Hidehiko Ikura ◽  
Toshinobu Ryuzaki ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pulmonary Hypertension ◽  
Exercise Tolerance ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Peak Vo2 ◽  
Balloon Pulmonary Angioplasty ◽  
Thromboembolic Pulmonary Hypertension ◽  
Hemodynamic Improvement

The efficacy of extensive balloon pulmonary angioplasty (BPA) beyond hemodynamic improvement in chronic thromboembolic pulmonary hypertension (CTEPH) patients has been verified. However, the relationship between extensive BPA in CTEPH patients after partial hemodynamic improvement and exercise tolerance or quality of life (QOL) remains unclear. We prospectively enrolled 22 CTEPH patients (66±10 years, females: 59%) when their mean pulmonary artery pressure initially decreased to <30 mmHg during BPA sessions. Hemodynamic and echocardiographic data, cardiopulmonary exercise testing, and QOL scores using the 36-item short form questionnaire (SF-36) were evaluated at enrollment (entry), just after the final BPA session (finish), and at the 6-month follow-up (follow-up). We analyzed whether extensive BPA improves exercise capacity and QOL scores over time. Moreover, the clinical characteristics leading to improvement were elucidated. The peak oxygen uptake (VO2) showed significant improvement at entry, finish, and follow-up (17.3±5.5, 18.4±5.9, and 18.9±5.3 mL/kg/min, respectively; P<0.001). Regarding the QOL, the physical component summary (PCS) scores significantly improved (32±11, 38±13, and 43±13, respectively; P<0.001), but the mental component summary scores remained unchanged. Linear regression analysis revealed that age and a low peak VO2 at entry were predictors of improvement in peak VO2, while low PCS scores and low TAPSE at entry were predictors of improvement in PCS scores. In conclusion, extensive BPA led to improved exercise tolerance and physical QOL scores, even in CTEPH patients with partially improved hemodynamics.

scholarly journals Hereditary hyperhomocysteinemia associated with nephrotic syndrome complicated by artery thrombosis and chronic thromboembolic pulmonary hypertension: A case report

2017 ◽  
Vol 87 (3) ◽  
Author(s):  
Paolo Ruggeri ◽  
Federica Lo Bello ◽  
Francesco Nucera ◽  
Michele Gaeta ◽  
Francesco Monaco ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Nephrotic Syndrome ◽  
Main Pulmonary Artery ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Exercise Intolerance ◽  
Artery Thrombosis ◽  
Stable Conditions ◽  
Thromboembolic Pulmonary Hypertension

We present here the case of a 30-year-old man with a long term history of nephrotic syndrome (NS) who developed an episode of acute left main pulmonary artery thrombosis complicated by a lung abscess. During the hospital admission was also identified a concomitant hyperhomocysteinemia. After an atypical resection of the left upper pulmonary lobe and the starting of long term anticoagulation the patient was discharged but did not attend the planned follow up visits until one year later when he was seen again for severe dyspnea and exercise intolerance. At this time chronic thromboembolic pulmonary hypertension (CTEPH) was diagnosed by lung perfusion scintigraphy and right heart catheterization. He initially refused the surgical treatment but, after six months, for the presence of worsening dyspnea was referred for bilateral pulmonary endarterectomy followed by a cardio-thoracic rehabilitation program. After a follow-up of seven years the patient is alive and in stable conditions. NS and hyperhomocysteinemia are both known risk factors for pulmonary embolism (PE), but their association with CTEPH is extremely rare. We discuss here the possible mechanisms linking these conditions. CTEPH must be suspected in any patient with NS, with or without hyperhomocysteinemia, and unexplained dyspnea.

Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension

1997 ◽  
Vol 5 (1) ◽  
pp. 35-38
Author(s):  
Gao Chang Qing ◽  
Rodolfo Barragan Garcia
Keyword(s):  
Pulmonary Hypertension ◽  
Median Sternotomy ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Pulmonary Thromboendarterectomy ◽  
Pulmonary Hemodynamic ◽  
Major Vessel ◽  
Thromboembolic Pulmonary Hypertension ◽  
Hemodynamic Improvement

We describe our experience of treating chronic major vessel thromboembolic pulmonary hypertension with pulmonary thromboendarterectomy. Thromboendarterectomy was performed in 15 patients through a median sternotomy incision using extracorporeal circulation and deep hypothermia. Postoperatively mean pulmonary artery pressure, mean pulmonary vascular resistance, and cardiac index were significantly improved (p < 0.001). Four patients died during surgery, mainly from perfusion edema (operative mortality 27%). The 11 surviving patients received long-term anticoagulant therapy and no incidence of thromboembolism has occurred during the follow-up period. All have shown sustained pulmonary hemodynamic improvement; however, there were 2 late deaths from cardiac failure. We conclude that thromboendarterectomy is an effective treatment for chronic major vessel thromboembolic pulmonary hypertension.

A Cohort Study Of 15,912 Patients On The Long-Term Quality Of Vka Therapy After Extreme Overanticoagulation

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2384-2384
Author(s):  
Hilde A.M. Kooistra ◽  
Nakisa Khorsand ◽  
Hanneke C. Kluin-Nelemans ◽  
Nic J.G.M. Veeger ◽  
Margriet Piersma ◽  
...  
Keyword(s):  
Vitamin K ◽  
Therapeutic Range ◽  
Time Interval ◽  
Thrombotic Risk ◽  
Total Group ◽  
The Mean ◽  
The Individual ◽  
Mean Time

Abstract Introduction Many patients are on long-term vitamin K antagonists (VKA) for atrial fibrillation (AF) or recurrent venous thromboembolism (VTE). This therapy proved highly effective for the prevention of stroke and recurrence of venous thrombosis. However, due to intra-individual variations in the dose-response relationship it can be difficult to keep the International Normalized Ratio (INR) within the therapeutic range. As underanticoagulation increases the thrombotic risk and overanticoagulation the bleeding risk, the efficacy and safety of VKA depend on the individual time in the therapeutic range (iTTR). Although patients on stable VKA therapy tend to stay stable over time, a proportion develops extreme overanticoagulation. It is well known that the iTTR is lowered directly after overanticoagulation. However, it is unclear whether such patients will subsequently restabilize. For that reason, we analyzed in a large cohort of AF and VTE patients the course of VKA therapy during the 3 months after extreme overanticoagualation. Material and Methods We selected from a consecutive cohort of 15,912 AF and VTE patients all patients who were on ‘stable VKA therapy’ during the 3 months ‘screening period’. The screening period started for the individual patient at the first INR between January 2009 and January 2012 that was measured ≥3 month after treatment initiation. Stable VKA therapy was defined by a maximum interval of 56 days between INR-measurements and the absence of extreme overanticoagulation (INR≥ 8.0 or unscheduled supplementation of vitamin K). End of follow-up was June 2012. In patients with extreme overanticoagulation (EO), we compared the 3 months before with the 3 months after EO. Patients with EO were also compared with the total group of selected patients. The primary outcome was inadequate iTTR (iTTR <65%), as we know from previous studies that the majority of major bleeds and thrombo-embolic events occurs in this relatively small group. Secondary outcomes were: time under and above the therapeutic range, iTTR (linear), and frequency of INR-measurements. Target INR was 2.0-3.5 according to Dutch guidelines. The iTTR was calculated for each individual patient using linear interpolation. INRs within 7 days before or after EO were not taken into account. Results We selected 14,417 stable patients: 11,194 AF and 3,223 VTE patients. During a total follow-up of 25,848 patient-years, 885 patients (3.4/100 patient-years) experienced EO. After EO, 731 (83%) patients continued VKA treatment. In the 3 months before EO, 50.0% of patients had an iTTR<65%. This increased with 16.6% (95% CI 14.3 – 19.2) to 66.7 % after EO. In patients who continued VKA treatment, the mean iTTR decreased with 7.1% (95%CI 4.6 – 9.6) from 64.2 to 57.2 after EO. The mean time above the therapeutic range only slightly decreased (3.9%, 95%CI 1.5 – 6.3) from 22.4% to 18.5%. Interestingly, the time below the therapeutic range almost doubled as it increased with 11.0% (95%CI 8.7 – 13.3) to 24.3%. The frequency of INR-measurements increased from a mean time interval of 18.4 to 14.0 days. In the total cohort of 14,417 patients, 18% of patients had an iTTR<65%. The mean time below, within and above the therapeutic range was 10.4%, 77.3% and 12.3%, respectively. Therefore, the RR risk of inadequate VKA therapy was 2.8 (95%CI 2,6 – 3.0) before and 3.7 (95%CI 3.5 – 4.0) after EO, compared to the total group. Conclusion Patients with EO had a significantly higher risk of inadequate VKA therapy compared to the total group of patients already in the 3 months before EO. After EO, the time below the therapeutic range increased, which could be caused by a counter reaction. This resulted in further deterioration of the iTTR. Thus, even with more frequent INR-measurements, adequate VKA therapy was not achieved for most of these patients. Although an episode of EO does alert staff, this does not lead to better control. These patients might be better candidates for one of the new oral anticoagulants. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Chronic thromboembolic pulmonary hypertension following long-term peripherally inserted central venous catheter use

2019 ◽  
Vol 9 (2) ◽  
pp. 204589401985947
Author(s):  
Abigail Masding ◽  
Stephen D. Preston ◽  
Mark Toshner ◽  
Joseph Barnett ◽  
Carl Harries ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Venous Catheter ◽  
Type I ◽  
First Case ◽  
Thromboembolic Pulmonary Hypertension ◽  
Mobile Mass ◽  
Life Threatening ◽  
The Right

A 36-year-old woman presented with recurrent pulmonary emboli (PE) despite oral anticoagulation. She was a type I diabetic with severe gastroparesis requiring insertion of multiple long-term peripherally inserted central catheters (PICC) over a 10-year period. Imaging at presentation demonstrated a PICC-associated mobile mass in the right atrium and signs of pulmonary hypertension (PH). She was thrombolyzed and fully anticoagulated, and diabetic management without PICC strongly recommended. PH persisted, however, and she developed chronic thromboembolic pulmonary hypertension (CTEPH), for which successful pulmonary endarterectomy (PEA) surgery led to symptomatic and hemodynamic improvement. This was the first case of CTEPH reported related to long-term PICC use outside the setting of malignant disease, and a novel observation that the PEA specimen contained multiple plastic fragments. Long-term PICC placement increases the risk of CTEPH, a life-threatening, albeit treatable, complication.

Physiological Pacing: A New Road to Future

2021 ◽  
pp. 263246362097804
Author(s):  
Vanita Arora ◽  
Pawan Suri
Keyword(s):  
Side Effects ◽  
Fibrous Tissue ◽  
Cardiac Pacing ◽  
His Bundle ◽  
Anatomy And Physiology ◽  
Long Term Follow Up ◽  
Pacing Lead ◽  
The Right

Anatomy and physiology are the basis of human body functioning and as we have progressed in management of various diseases, we have understood that physiological intervention is always better than an anatomical one. For more than 50 years, a standard approach to permanent cardiac pacing has been an anatomical placement of transvenous pacing lead at the right ventricular apex with a proven benefit of restoring the rhythm. However, the resultant ventricular dyssynchrony on the long-term follow-up in patients requiring more than 40% ventricular pacing led to untoward side effects in the form of heart failure and arrhythmias. To counter such adverse side effects, a need for physiological cardiac pacing wherein the electrical impulse be transmitted directly through the normal conduction system was sought. His bundle pacing (HBP) with an intriguing alternative of left bundle branch pacing (LBBP) is aimed at restoring such physiological activation of ventricles. HBP is safe, efficacious, and feasible; however, localization and placement of a pacing lead at the His bundle is challenging with existing transvenous systems due to its small anatomic size, surrounding fibrous tissue, long-learning curve, and the concern remains about lead dislodgement and progressive electrical block distal to the HBP lead. In this article, we aim to take the reader through the challenging journey of HBP with focus upon the hardware and technique, selective versus nonselective HBP, indications and potential disadvantages, and finally the future prospects.

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