Does thrombolysis for pulmonary embolism reduce the risk of chronic complications?

2021 ◽  
Vol 20 (1) ◽  
pp. 15-17
Author(s):  
Caroline Apsey ◽  
◽  
Muhammad Jawad ◽  
Martin Daschel ◽  
Daniel Woosey ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
Chronic Complications ◽  
The Right

We assessed the efficacy of thrombolysis in avoiding long-term complications. Notes of patients thrombolysed for PE in the 2-year period were reviewed. The initial CTPA and echocardiogram results before thrombolysis were compared to the results of follow up imaging repeated after 6 months. Twenty-two patients were thrombolysed for PE. 14 patients had sub-massive PE and 8 patients had massive PE. The right ventricle (RV) was dilated on pre-thrombolysis echocardiogram in 16 patients. On follow up echocardiography all patients with massive PE (6 studies) had a normal RV size, with pulmonary artery pressures (PAP) of 29mmHg. Follow up echocardiography of patients with submassive PE (13 studies) showed 11 patients with a normal RV, with PAP of 28 mmHg.

scholarly journals Adventitial Alterations Are the Main Features in Pulmonary Artery Remodeling due to Long-Term Chronic Intermittent Hypobaric Hypoxia in Rats

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Julio Brito ◽  
Patricia Siques ◽  
Silvia M. Arribas ◽  
Angel L. López de Pablo ◽  
M. Carmen González ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Inflammatory Cells ◽  
Cell Number ◽  
Hypoxic Conditions ◽  
Artery Remodeling ◽  
Medial Hypertrophy ◽  
The Right ◽  
Pulmonary Artery Remodeling

Long-term chronic intermittent exposure to altitude hypoxia is a labor phenomenon requiring further research. Using a rat model, we examined whether this type of exposure differed from chronic exposure in terms of pulmonary artery remodeling and other features. Rats were subjected to chronic hypoxia (CH,n=9) and long-term intermittent hypoxia (CIH2x2; 2 days of hypoxia/2 days of normoxia,n=10) in a chamber (428 Torr, 4,600 m of altitude) for 46 days and compared to rats under normoxia (NX,n=10). Body weight, hematocrit, and right ventricle ratio were measured. Pulmonary artery remodeling was assessed using confocal microscopy of tissues stained with a nuclear dye (DAPI) and CD11b antibody. Both hypoxic conditions exhibited increased hematocrit and hypertrophy of the right ventricle, tunica adventitia, and tunica media, with no changes in lumen size. The medial hypertrophy area (larger in CH) depicted a significant increase in smooth muscle cell number. Additionally, CIH2x2 increased the adventitial hypertrophy area, with an increased cellularity and a larger prevalence of clustered inflammatory cells. In conclusion, CIH2x2 elicits milder effects on pulmonary artery medial layer muscularization and subsequent right ventricular hypertrophy than CH. However, CIH2x2 induces greater and characteristic alterations of the adventitial layer.

Short- and Long-Term Outcomes of Catheter-Directed Thrombolysis versus Pulmonary Artery Embolectomy in Pulmonary Embolism: A National Population-Based Study

2021 ◽  
pp. 152660282110547
Author(s):  
Donna Shu-Han Lin ◽  
Yu-Sheng Lin ◽  
Jen-Kuang Lee ◽  
Wen-Jone Chen
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Hazard Ratio ◽  
Hospital Death ◽  
Research Database ◽  
Old Patients ◽  
Catheter Directed Thrombolysis ◽  
All Cause Mortality

Objectives: This study aimed to compare the short-term and long-term follow-up outcomes of catheter-directed thrombolysis (CDT) with those of pulmonary artery embolectomy (PAE) for patients with acute pulmonary embolism (PE) included in a nationwide cohort. Background: Data allowing direct comparisons between CDT and PAE are lacking in the literature, and the optimal management of high-risk and intermediate-risk PE is still debated. Methods: A retrospective cohort study was conducted with data for 2001 through 2013 collected from the Taiwan National Health Insurance Research Database (NHIRD). Patients who were first admitted for PE and treated with either CDT or PAE were included and compared. In-hospital outcomes included in-hospital death and safety (bleeding and cardiac arrhythmias) outcomes. Follow-up outcomes included all-cause mortality and recurrent PE during the 1- and 2-year follow-up periods and through the last follow-up. Inverse probability of treatment weighting (IPTW) based on the propensity score was used to minimize possible selection bias, including indices for multimorbidity such as the Charlson’s Comorbidity Index (CCI) and HAS-BLED scores. Results: A total of 389 patients treated between January 1, 2001, and December 31, 2013, were identified; 169 underwent CDT and 220 underwent PAE. After IPTW, there were no significant differences in in-hospital mortality (18.2% vs 21.3%; odds ratio 1.07, 95% confidence interval [CI]: 0.70–1.62) or the incidence of safety outcomes between the CDT and PAE groups. The risks of all-cause mortality (30% vs 29.5%; hazard ratio 1.16, 95% CI: 0.89–1.53), recurrent PE (7.2% vs 8.7%; subdistribution hazard ratio [SHR] 0.68, 95% CI: 0.39–1.21) and new-onset pulmonary hypertension (SHR 0.25, 95% CI: 0.05–1.32) were also not significantly different between the CDT and PAE groups at 2 years of follow-up. Subgroup analysis indicated that PAE may be associated with a more favorable 2-year mortality in patients <65 years old, patients with CCI scores of <3, patients with HAS-BLED scores of 1 to 2, and patients without cardiogenic shock (all P for interaction <.05). Conclusions: In patients with PE who required reperfusion therapy, CDT and PAE resulted in similar in-hospital and long-term all-cause mortality rates and long-term rates of recurrent PE. Bleeding risks were also comparable in the 2 groups.

Early and late outcomes of surgical repair of double-chambered right ventricle: a single-centre experience

2020 ◽  
Vol 30 (3) ◽  
pp. 409-412
Author(s):  
Murat Surucu ◽  
İlkay Erdoğan ◽  
Birgül Varan ◽  
Murat Özkan ◽  
N. Kürşad Tokel ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Right Ventricle ◽  
Septal Defect ◽  
Surgical Intervention ◽  
Systolic Pressure ◽  
Presenting Symptoms ◽  
Long Term Follow Up ◽  
The Right

AbstractObjective:Double-chambered right ventricle is characterised by division of the outlet portion of the right ventricle by hypertrophy of the septoparietal trabeculations into two parts. We aim to report our experiences regarding the presenting symptoms of double-chambered right ventricle, long-term prognosis, including the recurrence rate and incidence of arrhythmias after surgery.Methods:We retrospectively investigated 89 consecutive patients who were diagnosed to have double-chambered right ventricle and underwent a surgical intervention from 1995 to 2016. The data obtained by echocardiography, cardiac catheterisation, and surgical findings as well as post-operative follow-up, surgical approaches, post-operative morbidity, mortality, and cardiac events were evaluated.Results:Median age at the time of diagnosis was 2 months and mean age at the time of operation was 5.3 years. Concomitant cardiac anomalies were as follows: perimembranous ventricular septal defect (78 patients), atrial septal defect (9 patients), discrete subaortic membrane (32 patients), right aortic arch (3 patients), aortic valve prolapse and/or mild aortic regurgitation (14 patients), and left superior caval vein (2 patients). The mean follow-up period was 4.86 ± 4.6 years. In these patients, mean systolic pressure gradient in the right ventricle by echocardiography before, immediately, and long-term after surgical intervention was 66.3, 11.8, and 10.4 mmHg, respectively. There were no deaths during the long-term follow-up period. Surgical reinterventions were performed for residual ventricular septal defect (2), residual pulmonary stenosis (1), and severe tricuspid insufficiency (1).Conclusion:The surgical outcomes and prognosis of double-chambered right ventricle are favourable, recurrence and fatal arrhythmias are unlikely in long-term follow-up.

P4355Echocardiographic estimation of right ventricle wall tension: hemodynamic comparison and long term follow up

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
U Annone ◽  
P Omede' ◽  
F D'Ascenzo ◽  
A Montefusco ◽  
A Milan ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Right Atrial ◽  
Stroke Work ◽  
Work Index ◽  
All Cause Mortality ◽  
Long Term Follow Up ◽  
Stroke Work Index

Abstract Introduction Prognosis in pulmonary hypertension (PH) is strictly linked to right ventricle (RV) failure, which results from uncoupling between RV and the superimposed pressure load; in first phases, coupling between these two actors still be preserved, at the price of augmented right ventricle wall tension (RVWT). Purpose We sought to describe how to estimate RVWT with echocardiography, how it correlates with RV hemodynamics and if it may predict prognosis. Methods A total of 190 patients without overt RV failure, with suspected pulmonary hypertension (PH) to a previous echocardiography, underwent to right heart catheterization (RHC) and nearly-simultaneous echocardiography. We estimated RVWT according to Laplace law (RV length × tricuspid regurgitation peak gradient [TRPG]), in order to predict initial RV stress, and was correlated with RV hemodynamic profile; its potential prognostic impact was tested along with canonical RV function parameters. Results In patients enrolled in our study, RVWT correlated significantly with invasive estimation of right ventricle end diastolic pressure (R 0.343, p<0.001); a significant relationship between RVWT and several hemodynamic variables was observed (mean pulmonary artery pressure, pulmonary artery compliance, transpulmonary gradient, pulmonary vascular resistance, RV telediastolic pressure, right atrial pressure, RV stroke work index; all p<0.001). At a mean follow up of five years and three months, only RVWT predicted all-cause mortality (p 0.036), while TAPSE, TAPSE/TRPG, RV fractional area change and RV S' wave did not. Correlation: RWVT and RV hemodynamic Hemodynamic variable R R2 p value Mean pulmonary artery pressure 0.742 0.550 <0.001 RV differential pressure 0.794 0.630 <0.001 Pulmonary artery pulsatory pressure 0.740 0.547 <0.001 Mean right atrium pressure 0.326 0.106 <0.001 Cardiac index/right atrial pressure 0.209 0.044 0.012 RV stroke work index 0.588 0.346 <0.001 Pulmonary artery compliance 0.449 0.202 <0.001 Pulmonary vascular resistance 0.531 0.282 <0.001 Prognosis: different RV variables Discussion We identified a novel bedside echocardiographic predictor of altered RV hemodynamic, which results precociously altered in patients without overt RV failure, and able to predict all cause mortality at a long term follow up. Further studies are needed to confirm its role in PH patients.

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 Myocardial tissue function and characterization in patients with idiopathic cardiac magnetic resonance myopericarditis: evolutionary analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Soeiro ◽  
A S Bossa ◽  
M C Cesar ◽  
T C A T Leal ◽  
G Garcia ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Tissue Characterization ◽  
Late Enhancement ◽  
Left Ventricular ◽  
Volume Index ◽  
Systolic Volume ◽  
End Systolic Volume ◽  
The Right

Abstract Introduction The identification of prognostic markers related to the occurrence of events and recovery of ventricular function may be important in patients with acute myopericarditis (AMP). There is still a lack of data related to tissue characterization by cardiac magnetic resonance (CMR) of AMP, evolution and definition of possible long-term prognostic markers. Purpose To evaluate the myocardial tissue characterization of CMR related to the occurrence of combined events (death from all causes, heart failure and AMP recurrence) and the increase in left ventricular ejection fraction (LVEF) in patients with AMP. Methods Inclusion criteria were chest pain and/or electrocardiographic changes associated with elevated troponin (above the 99th percentile) in the absence of coronary stenosis and diagnosis of AMP by CMR &lt;48 hours of admission confirmed by the presence of edema and/or late enhancement. After a follow-up of up to 24 months, 100 patients remained and in the assessment of the increase in LVEF (increase &gt;5%), 36 cases remained, recalled for a new CMR between 6 and 18 months from the initial event. Results Significant differences in CMR were found between patients who had combined events (n=26) versus no combined events (n=74) in the following characteristics evaluated: initial LVEF (OR=0.938; CI: 0.895–0.984, p=0.008), left ventricular (LV) systolic volume index (OR=1.034; CI: 1.005–1.062, p=0.019), LV diastolic volume index (OR=1.029; CI: 1.002–1.056, p=0.038), presence of hypersignal in T2 (OR=11.325; CI: 2.247–57.075, p=0.003), presence of late anteroseptal enhancement (OR=0.160; CI: 0.037–0.685, p=0.014), basal anteroseptal (OR=0.255; CI: 0.071–0.914, p=0.036) and lateral apical (OR=5.902; CI: 1.236–28.187, p=0.026). In relation to the increase in LVEF, significant differences were found in CMR in the following characteristics evaluated: LVEF (OR=0.870; CI: 0.758–0.988, p=0.047), end systolic volume of the right ventricle (OR=1.047; CI: 1.001–1.096, p=0.047), LV systolic diameter (OR=1.283; CI: 1.034–1.593, p=0.023), LV diastolic diameter (OR=1.225; CI: 1.012–1.482, p=0.038), LV systolic volume index (OR=1.340; CI: 1.066–1.685, p=0.012), LV diastolic volume index (OR=1.111; CI: 1.017–1.213, p=0.019) and right ventricular systolic volume index (OR=1.116; CI: 1.006–1.236, p=0.037). Conclusion We observed a significant association between combined events in the long-term follow-up with initial LVEF, LV systolic and diastolic volume indexes, T2 hypersignal and the presence of mid and basal anteroseptal and lateral apical late enhancement. Already related to the increase in LVEF in evolutionary CMR, we observed a significant association with initial LVEF, end systolic volume of the right ventricle, LV systolic and diastolic diameters, LV systolic and diastolic volume indexes and right ventricle systolic volume index. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): FAPESP

A retrospective review of patients with massive and submassive pulmonary embolism treated with AngioJet rheolytic thrombectomy with decreased complications due to changes in thrombolytic use and procedural modifications

Vascular ◽  
2017 ◽  
Vol 26 (2) ◽  
pp. 163-168 ◽  
Author(s):  
Sundeep Das ◽  
Nikhil Das ◽  
Harvey Serota ◽  
Sriram Vissa
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Retrospective Review ◽  
Bleeding Complications ◽  
Submassive Pulmonary Embolism ◽  
Short Run ◽  
Rheolytic Thrombectomy ◽  
Procedural Modification

Objectives A retrospective review of treatment of patients with massive or submassive pulmonary embolism (PE) using AngioJet rheolytic thrombectomy (ART) system with procedural modifications to improve on the previously reported outcomes. Materials and Methods Thirteen patients underwent emergent pulmonary artery thrombectomy for massive and submassive PE using ART with pharmacological and procedural modification, in comparison to prior reports. The modifications included the selective use of the Solent Omni AngioJet device in all subjects, distal contrast angiography via the AngioJet catheter before device activation, and limited short run times. Thrombolytic therapy was not used in any patient. Patients were monitored for short- and long-term outcomes. Long-term clinical follow-up and evaluation for persistent pulmonary hypertension with echocardiography was performed. Results The pharmacological and procedural modifications resulted in a favorable clinical response without any major complications and without any mortality. Procedure-related anemia (mean hemoglobin drop of 0.49 g/dl) was the only significant minor complication noted. There were no bleeding complications and no transfusion requirement. On a six-month follow-up, there was no mortality, and there were significant reductions in the pulmonary artery pressures. Conclusion Major and minor complications were reduced compared to prior reports using ART. A modified ART approach towards treatment of high-risk PE appears promising both in terms of efficacy and safety.

scholarly journals Huge right ventricle cardiac fibroma in a child patient

2021 ◽  
Author(s):  
Qiang Fan ◽  
Yunfei Ling ◽  
Qi An
Keyword(s):  
Right Ventricle ◽  
Heart Function ◽  
Pathological Examination ◽  
Borderline Tumor ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Child Patient ◽  
The Right

In this case report, we describe a rare large right ventricular fibroma with sudden chest pain in a 9 year old child. The tumor was successfully surgical removed under cardiopulmonary bypass, but there was only a small remnant of the tumor to avoid rupture of the right ventricle and injury to the tricuspid valve. Pathological examination confirmed that the tumor was fibrous borderline tumor. The patient’s heart function and the size of atrium and ventricles were normal, and there was no tricuspid regurgitation at 3-months follow-up. It was reported that the age less than 17 years old at time of diagnosis are associated with a poor prognosis, the long term outcome for this children patient needs further follow-up.

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