scholarly journals Possibilities of Surgical Treatment of Pulmonary Embolism in Patients After Spinal Surgery

2021 ◽  
Vol 10 (2) ◽  
pp. 377-384
Author(s):  
S. A. Fedorov ◽  
A. P. Medvedev ◽  
L. Ya. Kravets ◽  
L. M. Tselousova
Keyword(s):  
Pulmonary Embolism ◽  
Surgical Treatment ◽  
High Risk ◽  
Pulmonary Artery ◽  
Spinal Surgery ◽  
Clinical Manifestations ◽  
Early Postoperative Period ◽  
High Risk Group ◽  
Main Stage ◽  
Cardiovascular Failure

Aim of study. Comprehensive assessment of clinical and hemodynamic results of surgical treatment of high- and intermediate-high risk of pulmonary embolism in a group of patients who underwent spinal surgery.Materials and methods. The analysis of the results of open surgical treatment of pulmonary embolism in high- and intermediate-high-risk patients after neurosurgical operations on the spine in the period from 2013 through 2019. The study group included 5 patients. The average age of patients was 59.74±3.42 years. The Wells index was 9.2±2.4. The Pesi index of the studied patients was in the range of 100–126, which allowed them to be classified as a high-risk group of 30-day mortality (class IV). Clinical manifestations of pulmonary embolism developed on average by 5.8±1.08 days after the initial neurosurgical intervention. The calculated pressure in the pulmonary artery was 56.6±8.22 mm Hg. In all cases, surgical intervention was performed for emergency indications, in conditions of artificial blood circulation, without aortic compression during the main stage of the operation.Results. The 30-day survival rate of patients was 100%. Among non-lethal postoperative complications, acute cardiovascular failure and hepatic-renal failure prevailed, which were levelled by the time the patients were transferred to a cardiac hospital. In 1 patient, the early postoperative period was complicated by the development of exudative pericarditis with cardiac tamponade, which required a finger revision of the anterior mediastinum, its drainage for 2 days. In all cases, there was an improvement in the condition of patients, in the form of increased tolerance to physical activity. The estimated pressure in the pulmonary artery at the time of discharge was 24.69±8.03 mm Hg.Conclusions. Surgical treatment of acute pulmonary embolism of high- and intermediate-high risk of early death in a group of patients with a neurosurgical profile is a highly effective and reliable method with great prospects for application. 

scholarly journals Clinical and angiopulmonographic association in pulmonary embolism

2021 ◽  
Vol 93 (4) ◽  
pp. 363-368
Author(s):  
Evgeniy S. Mazur ◽  
Vera V. Mazur ◽  
Robert M. Rabinovich ◽  
Mariya A. Bachurina
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Pulmonary Artery ◽  
Clinical Manifestations ◽  
Low Risk ◽  
Intermediate Risk ◽  
Pulmonary Infarction ◽  
Risk Patients ◽  
Pulmonary Artery Obstruction ◽  
Artery Obstruction

Aim. To detect the effect of the feature of the pulmonary vascular obstruction on the clinical manifestations of pulmonary embolism (PE). Materials and methods. The 127 patients with PE were included in this study. PE verified with multidetector computed tomography with pulmonary angiography. Among them were 57 patients with high-risk PE, and 39 patients with intermediate-risk PE and 31 patients with low-risk PE. The pulmonary artery obstruction index and the obstruction level were determined. Results. The mean values of the pulmonary artery obstruction index in high and intermediate risk patients were 42.5%, and in low risk patients 12.5% (p0.001). The trunk or main branches obstruction was in 80.7% of high-risk PE patients, the main or lobar branches obstruction in 92.3% of intermediate-risk patients and lobar or segmental branches obstruction in 93.5% of low-risk patients. Pulmonary infarction was detected in 89.2% of patients with the segmental branches obstruction and with another level of obstruction in 28.0% of patients only (p0.001). Conclusion. The hemodynamic disorder in pulmonary embolism associate with the pulmonary artery obstruction index of more than 30%. The development of obstructive shock is associated with the pulmonary artery trunk obstruction, and the development of pulmonary infarction associated with the segmental branches obstruction.

scholarly journals Clinical significance of peculiarities of the lesions of the vascular bed associated with pulmonary thromboembolism

2017 ◽  
Vol 95 (5) ◽  
pp. 394-397
Author(s):  
M. A. Bachurina ◽  
V. V. Mazur ◽  
E. S. Mazur
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Pulmonary Artery ◽  
Main Pulmonary Artery ◽  
Clinical Manifestations ◽  
Pulmonary Angiography ◽  
Community Acquired Pneumonia ◽  
Low Risk ◽  
Risk Patients ◽  
Vascular Obstruction

Aim. To study effect of the level of vascular obstruction on the clinical manifestations of pulmonary embolism (PE). Material and methods. 63 patients with PE were included in this study. PE was verified by multidetector computed tomography (MSCT) with pulmonary angiography. 43 patients with high-risk PE survived the first week of the disease. In the remaining 20 patients with community-acquired pneumonia PE was diagnosed using MSCT pulmonary angiography in the first week of illness. Results. Obstruction of the trunk of the pulmonary artery or its lobar branches was detected in 34 (79.1%) patients with a high risk of PE and in only 2 (10%) ones with low-risk PE (p <0,001). The development of pneumonia complicated the course of the disease in 14 (32.6%) patients with a high risk of pulmonary embolism. The clots in the segmental branches of the pulmonary artery were identified in 9 (64.3%) patients with pneumonia. In high-risk patients with PE without pneumonia the lesion of segmental branches was detected only in 1 (3.4%) case (p <0,001). In patients with pneumonia at low risk of PE, the obstruction segmental branches was detected in 17 (85%) cases. Conclusion. The development of obstructive shock in PE is associated with a trunk embolism and/or the main pulmonary artery branches embolism. Infarction pneumonia is associated with the lesions of segmental branches of the pulmonary artery.

scholarly journals Features of diagnostics and surgical treatment of right ventricular thrombosis complicated by pulmonary artery thromboembolism (clinical case)

2019 ◽  
pp. 67-71
Author(s):  
R. M. Vitovsky ◽  
P. M. Semeniv ◽  
A. O. Rusnak ◽  
Y. R. Ivanov ◽  
V. F. Onischenko
Keyword(s):  
Pulmonary Embolism ◽  
Surgical Treatment ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
Right Ventricular ◽  
Young Patients ◽  
The Body ◽  
Blood Clots ◽  
The Right ◽  
Clinical Conditions

The case of differential diagnosis and treatment of a patient with pulmonary embolism (PE), the source of which was the thrombus formed in the right ventricle of the heart, is presented. The peculiarity of this case was the untimely diagnosis of the disease, which simulated pneumonia, the treatment of which did not improve the clinical condition of the patient. Tomography allowed to determine the thrombosis of the right branch of the pulmonary artery and to send the patient to the cardiac surgery center for further treatment. Diagnosis of a probable source of embolism occurred after echocardiography, which revealed a tumor-like lesion of the right ventricle of large size and dense consistency. The results of surgical treatment of the patient, during which extensive formation of the right ventricle was removed, a dense elastic consistency with signs of fragmentation confirmed the prediction of this particular source of pulmonary embolism. Removal of blood clots from the right branch of the pulmonary embolism showed their similar macrostructure with right ventricular formation. The appearance and macrostructure of the formation did not allow to determine with certainty its character. Only histological examination was able to determine the thrombogenicity of the origin of this formation. The recurrent nature of pneumonia, without the presence of risk factors, in young patients may be the basis for more thorough examination to identify atypical clinical conditions. The restoration of the source of the body is of great importancefor the prevention of its relapse. Finding the source of pulmonary embolism should necessarily include echocardiography to carefully examine possible lesions of intracardiac structures with the formation of blood clots that may be responsible for its occurrence.

scholarly journals SURGICAL TREATMENT OF CAROTID STENOSIS IN PATIENTS WITH CORONARY HEAR+T DISEASE IN ORDER TO PREVENT ISCHEMIC STROKE

2020 ◽  
pp. 124-126
Author(s):  
I. S. Pulyaeva ◽  
V. A. Prasol
Keyword(s):  
Ischemic Stroke ◽  
Surgical Treatment ◽  
Carotid Stenosis ◽  
Postoperative Period ◽  
Stable State ◽  
Length Of Hospital Stay ◽  
Early Postoperative Period ◽  
Main Stage ◽  
Simultaneous Operations ◽  
Ischemic Attack

Summary. Goal. To analyze the results of surgical treatment of carotid stenosis in patients with coronary heart disease in order to prevent ischemic stroke. Materials and methods. The analysis included 18 patients treated in the SI «V. T. Zaitseva IGUS of NAMNU» from 2017 to 2019 in combined atherosclerotic lesions of the coronary and carotid arteries which evaluated the reserve brain. Results and discussion. All patients with two-stage treatment of the first and second groups were discharged in a stable state, one had a clinic of transient ischemic attack in the postoperative period. Conclusions. Simultaneous operations are advisable in patients with a reduced reserve of both coronary and cerebral circulation. The risk of developing cerebral and cardiac postoperative complications is comparable with the results of phased operations, reducing the length of hospital stay of the patient. The results of the hypoxic test serve as an additional criterion for the decision to impose an internal intra-arterial shunt. This allows you to reduce the time of the main stage of carotid endarterectomy and to avoid additional possible complications in the early postoperative period.

scholarly journals Risk stratification of normotensive pulmonary embolism: prognostic impact of copeptin

2015 ◽  
Vol 46 (6) ◽  
pp. 1701-1710 ◽  
Author(s):  
Kristian Hellenkamp ◽  
Johanna Schwung ◽  
Heidi Rossmann ◽  
Anja Kaeberich ◽  
Rolf Wachter ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Risk Stratification ◽  
Adverse Outcome ◽  
Troponin T ◽  
High Sensitivity ◽  
High Risk Group ◽  
Low Risk ◽  
Prognostic Impact ◽  
Increased Risk

The prognostic value of copeptin, the C-terminal fragment of the precursor protein of vasopressin which is released upon stress, and hypotension in pulmonary embolism is unknown, especially if combined with biomarkers reflecting different pathophysiological axes such as myocardial injury (high-sensitivity troponin T (hsTnT)) and stretch (N-terminal pro-brain natriuretic peptide (NT-proBNP)).We prospectively studied 268 normotensive pulmonary embolism patients included in a single-centre cohort study.Patients with an adverse 30-day outcome (5.6%) had higher copeptin levels than patients with a favourable course (median (interquartile range) 51.8 (21.6–90.8) versus 13.2 (5.9–39.3) pmol·L−1; p=0.020). Patients with copeptin levels above the calculated optimal cut-off value of 24 pmol·L−1 had a 5.4-fold increased risk for an adverse outcome (95% CI 1.68–17.58; p=0.005). We developed a strategy for risk stratification based on biomarkers. None of 141 patients (52.6%) with hsTnT <14 pg·mL−1 or NT-proBNP <600 pg·mL−1 had an adverse outcome (low risk). Copeptin ≥24 pmol·L−1 stratified patients with elevated hsTnT and NT-proBNP as intermediate–low and intermediate–high risk (5.6% and 20.0% adverse outcome, respectively). Compared to the algorithm proposed by the 2014 European Society of Cardiology guideline, more patients were classified as low risk (52.8% versus 17.5%, p<0.001) and more patients in the intermediate–high risk group had an adverse outcome (20.0% versus 11.6%).Copeptin might be helpful for risk stratification of normotensive patients with pulmonary embolism, especially if integrated into a biomarker-based algorithm.

scholarly journals GRACE score in assessing the risk of hospital outcomes in patients with pulmonary embolism

2018 ◽  
pp. 25-31
Author(s):  
I. S. Mullova ◽  
N. A. Cherepanova ◽  
T. V. Pavlova ◽  
S. M. Khokhlunov ◽  
D. A. Gnilomedova ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk ◽  
Bundle Branch Block ◽  
T Wave ◽  
Wave Inversion ◽  
Grace Score ◽  
Very High

Aim. To compare the PESI and GRACE scores in assessing the risk of hospital outcomes in patients with pulmonary embolism.Material and methods. The study included 383 patients with pulmonary embolism (PE), hospitalized during the period of April 4, 2003 on September 18, 2014; 190 (49,6%) are men, the average age is 57,4 years±14,4 years. We considered the patient’s anamnesis, complaints, results of biochemical and instrumental tests, as well as the treatment carried out to the patients.Results. According to the risk stratification of PESI score, 86 (22,5%) patients had a very low risk of death, 88 (22,9%) had a low risk, 94 (24,5%) had an intermediate risk, 60 (15,%) — high risk and 55 (14,4%) patients have a very high risk. The combination of three ECG signs (SI-QIII, right bundle branch block and T-wave inversion in V1-V3) was significantly more common in patients with a very high PE risk — 14,5% (p=0,025). The most reliable sign of the most echographic (echoCG) criteria was dilatation of right ventricle (RV) (p=0,009) in a group of patients with a very high PE risk. According to the GRACE scale, 112 (29,2%) patients were assigned to the low risk group, and 271 (70,8%) patients — to the high risk group. ECG signs were observed more frequently in the high risk group: SI-QIII, T-wave inversion in III, V1-V3 leads, right bundle branch block (p<0,05). Pulmonary hypertension and RV dilatation according to echoCG prevailed in the high risk group (98,4% and 85,1%, respectively), p<0,05. The minimum value of points on the GRACE score for the deceased patients was 118 points. The GRACE scale showed high predictive ability with a sensitivity of 96% and a specificity of 63% (AUC=0,811, CI 95% 0,0738-0,884). However, the PESI score had a slightly greater predictive value with a sensitivity of 100% and a specificity of 53% (AUC=0,879 compared with AUC=0,811 for the GRACE scale). Analysis of the PESI and GRACE scores showed a moderate correlation between them (r=0,668).Conclusion. The GRACE score showed a high predictive value for adverse outcomes in PE patients with a sensitivity of 96% and a specificity of 63%. The minimum score on the GRACE score for deceased patients was 118 points.

АSSESMENT OF PRIMARY CARE PHYSICIAN ABOUT TOTAL CARDIOVASCULAR RISK

2020 ◽  
Vol 2 (1) ◽  
pp. 81-84
Author(s):  
Sanjar Kholboyev ◽  
Keyword(s):  
Cardiovascular Risk ◽  
High Risk ◽  
Risk Evaluation ◽  
Risk Group ◽  
Clinical Manifestations ◽  
High Risk Group ◽  
Care Physician ◽  
Coronary Risk ◽  
Asymptomatic Patients ◽  
Risk Scale

In practical medicine, the assessment of total cardiovascular risk (CVR) plays an important role in identifying a high-risk group among “asymptomatic” patients, that is, individuals without clinical manifestations of atherosclerosis. Currently, the most famous are the American Framingham Total Coronary Risk Scale, as well as the European SCORE (Systematic Coronary Risk Evaluation) scale, which predicts the 10-year fatal risk of all CVDs for European countries with low and high risk. The survey involved 66 doctors from various regions of Uzbekistan

scholarly journals Present aspects of thrombolytic therapy of pulmonary artery thromboembolism

2021 ◽  
Vol 99 (1) ◽  
pp. 6-14
Author(s):  
Y. V. Ovchinnikov ◽  
M. V. Zelenov ◽  
V. S. Polovinka ◽  
E. V. Kryukov
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Pulmonary Artery ◽  
Thrombolytic Therapy ◽  
Pulmonary Blood Flow ◽  
Pulmonary Thromboembolism ◽  
Comparative Efficiency ◽  
Artery Embolism ◽  
Pulmonary Arterial ◽  
Pulmonary Artery Embolism

The concept of high-risk pulmonary artery embolism determines that verification of the occlusion of the pulmonary arterial bed requires urgent restoration of pulmonary blood flow in such patients. Thrombolytic therapy is currently recognized as the main treatment for pulmonary artery thromboembolism. It can save patients’ lives, prevent the development of chronic post embolic pulmonary hypertension and thromboembolism recurrence. The literature review presents thrombolytic medications used in the treatment of pulmonary thromboembolism, describes indications for thrombolytic therapy, comparative efficiency and safety of various thrombolytics. The main complications of thrombolytic therapy are described and the issues of increasing its safety are raised. Criteria for the success of thrombolysis are early diagnosis, accurate risk stratification, and adequate use of reperfusion agents in patients with high-risk or transitionally high-risk of pulmonary embolism.

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