Open Thromboembolectomy for Massive and Submassive Pulmonary Embolism in High-Risk Patients

Flebologiia ◽  
2020 ◽  
Vol 14 (4) ◽  
pp. 296
Author(s):  
G.G. Khubulava ◽  
A.M. Volkov ◽  
E.K. Gavrilov ◽  
S.V. Sadovoy
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
High Risk Patients ◽  
Submassive Pulmonary Embolism ◽  
Risk Patients

Right Atrial Thrombosis and Pulmonary Embolism: A Narrative Review

2020 ◽  
Vol 46 (08) ◽  
pp. 895-907
Author(s):  
Nina D. Anfinogenova ◽  
Oksana Y. Vasiltseva ◽  
Alexander V. Vrublevsky ◽  
Irina N. Vorozhtsova ◽  
Sergey V. Popov ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Embolism ◽  
High Risk ◽  
Transesophageal Echocardiography ◽  
Three Dimensional ◽  
Right Atrial ◽  
Treatment Protocols ◽  
High Risk Patients ◽  
Risk Patients ◽  
The Right

AbstractPrompt diagnosis of pulmonary embolism (PE) remains challenging, which often results in a delayed or inappropriate treatment of this life-threatening condition. Mobile thrombus in the right cardiac chambers is a neglected cause of PE. It poses an immediate risk to life and is associated with an unfavorable outcome and high mortality. Thrombus residing in the right atrial appendage (RAA) is an underestimated cause of PE, especially in patients with atrial fibrillation. This article reviews achievements and challenges of detection and management of the right atrial thrombus with emphasis on RAA thrombus. The capabilities of transthoracic and transesophageal echocardiography and advantages of three-dimensional and two-dimensional echocardiography are reviewed. Strengths of cardiac magnetic resonance imaging (CMR), computed tomography, and cardiac ventriculography are summarized. We suggest that a targeted search for RAA thrombus is necessary in high-risk patients with PE and atrial fibrillation using transesophageal echocardiography and/or CMR when available independently on the duration of the disease. High-risk patients may also benefit from transthoracic echocardiography with right parasternal approach. The examination of high-risk patients should involve compression ultrasonography of lower extremity veins along with the above-mentioned technologies. Algorithms for RAA thrombus risk assessment and protocols aimed at identification of patients with RAA thrombosis, who will potentially benefit from treatment, are warranted. The development of treatment protocols specific for the diverse populations of patients with right cardiac thrombosis is important.

scholarly journals Pulmonary embolism: the role of emergency scan and intervening radiology in medium-high-risk patients with pulmonary embolism

2010 ◽  
Vol 6 (1) ◽  
pp. 5
Author(s):  
Eleonora Arboscello ◽  
Irene Ponassi ◽  
Agnese Lomeo ◽  
Maria Nives Parodi ◽  
Paolo Barbera ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Negative D-dimer testing excludes pulmonary embolism in non-high risk patients in the emergency department

2017 ◽  
Vol 24 (3) ◽  
pp. 273-280 ◽  
Author(s):  
John B. Harringa ◽  
Rebecca L. Bracken ◽  
Scott K. Nagle ◽  
Mark L. Schiebler ◽  
Michael S. Pulia ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
High Risk ◽  
High Risk Patients ◽  
Risk Patients ◽  
D Dimer

scholarly journals MR-proADM and MR-proANP levels in patients with acute pulmonary embolism

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Önsel Öner ◽  
Figen Deveci ◽  
Selda Telo ◽  
Mutlu Kuluöztürk ◽  
Mehmet Balin
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Acute Pulmonary Embolism ◽  
Low Risk ◽  
Control Group ◽  
High Risk Patients ◽  
Risk Patients ◽  
The Relationship

Summary Background The aim of this study was to determine levels of Mid-regional Pro-adrenomedullin (MR-proADM) and Mid-regional Pro-atrial Natriuretic Peptide (MR-proANP) in patients with acute pulmonary embolism (PE), the relationship between these parameters and the risk classification in addition to determining the relationship between 1- and 3-month mortality. Methods 82 PE patients and 50 healthy control subjects were included in the study. Blood samples for MR-proANP and MR-proADM were obtained from the subjects prior to the treatment. Risk stratification was determined according to sPESI (Simplified Pulmonary Embolism Severity Index). Following these initial measurements, cases with PE were assessed in terms of all causative and PE related mortalities. Results The mean serum MR-proANP and MR-proADM levels in acute PE patients were found to be statistically higher compared to the control group (p < 0.001, p < 0.01; respectively) and statistically significantly higher in high-risk patients than low-risk patients (p < 0.01, p < 0.05; respectively). No statistical difference was determined in high-risk patients in case of sPESI compared to low-risk patients while hospital mortality rates were higher. It was determined that the hospital mortality rate in cases with MR-proANP ≥ 123.30 pmol/L and the total 3-month mortality rate in cases with MR-proADM ≥ 152.2 pg/mL showed a statistically significant increase. Conclusions This study showed that MR-proANP and MR-proADM may be an important biochemical marker for determining high-risk cases and predicting the mortality in PE patients and we believe that these results should be supported by further and extensive studies.

scholarly journals Prognostic impact of copeptin in pulmonary embolism: a multicentre validation study

2018 ◽  
Vol 51 (4) ◽  
pp. 1702037 ◽  
Author(s):  
Kristian Hellenkamp ◽  
Piotr Pruszczyk ◽  
David Jiménez ◽  
Anna Wyzgał ◽  
Deisy Barrios ◽  
...  
Keyword(s):  
At Risk ◽  
Pulmonary Embolism ◽  
High Risk ◽  
Risk Stratification ◽  
Adverse Outcome ◽  
Adverse Outcomes ◽  
Prognostic Impact ◽  
High Risk Patients ◽  
Increased Risk ◽  
Risk Patients

To externally validate the prognostic impact of copeptin, either alone or integrated in risk stratification models, in pulmonary embolism (PE), we performed a post hoc analysis of 843 normotensive PE patients prospectively included in three European cohorts.Within the first 30 days, 21 patients (2.5%, 95% CI 1.5–3.8) had an adverse outcome and 12 (1.4%, 95% CI 0.7–2.5) died due to PE. Patients with copeptin ≥24 pmol·L−1 had a 6.3-fold increased risk for an adverse outcome (95% CI 2.6–15.5, p<0.001) and a 7.6-fold increased risk for PE-related death (95% CI 2.3–25.6, p=0.001). Risk classification according to the 2014 European Society of Cardiology (ESC) guideline algorithm identified 248 intermediate-high-risk patients (29.4%) with 5.6% (95% CI 3.1–9.3) at risk of adverse outcomes. A stepwise biomarker-based risk assessment strategy (based on high-sensitivity troponin T, N-terminal pro-brain natriuretic peptide and copeptin) identified 123 intermediate-high-risk patients (14.6%) with 8.9% (95% CI 4.5–15.4) at risk of adverse outcomes. The identification of patients at higher risk was even better when copeptin was measured on top of the 2014 ESC algorithm in intermediate-high-risk patients (adverse outcome OR 11.1, 95% CI 4.6–27.1, p<0.001; and PE-related death OR 13.5, 95% CI 4.2–43.6, p<0.001; highest risk group versus all other risk groups). This identified 85 patients (10.1%) with 12.9% (95% CI 6.6–22.0) at risk of adverse outcomes and 8.2% (95% CI 3.4–16.2) at risk of PE-related deaths.Copeptin improves risk stratification of normotensive PE patients, especially when identifying patients with an increased risk of an adverse outcome.

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