scholarly journals Immediate results of surgical treatment of high and intermediate risk pulmonary embolism in elderly and senile patients

2022 ◽  
Vol 99 (7-8) ◽  
pp. 451-456
Author(s):  
S. A. Fyodorov ◽  
A. P. Medvedev ◽  
L. M. Tselousova ◽  
N. Yu. Borovkova ◽  
R. A. Deryabin ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Surgical Treatment ◽  
Pulmonary Artery ◽  
Peak Pressure ◽  
Intermediate Risk ◽  
Average Pressure ◽  
General Group ◽  
Miller Index ◽  
Hospital Survival ◽  
Time Of Operation

The aim of the study: is to analyze the immediate results of surgical treatment of high-and intermediate-risk PE in a group of elderly and senile patients. Material and methods. The study included 43 patients operated on for high-and intermediate-risk pulmonary embolism between 2008 and 2019. In the general group of patients, the number of women prevailed and amounted to 67.4%. The average age was 65.4 ± 4.23 years old. The Miller index in the general group was 29.1 ± 1.42. The Geneva Index was 8.4 ± 1.12. The average pressure in the pulmonary artery at the time of operation was 54 ± 1.4 mm Hg, and the peak pressure was 68 ± 3.43 mm Hg. Results. 5 patients died at the hospital stage. Thus, the hospital survival rate of patients was 88.4%. Among nonlethal complications, cardiovascular and respiratory failure prevailed. According to the statement, the calculated pressure gradient in the pulmonary artery was 29.0 ± 3.1 mm Hg. Conclusion. Surgical treatment is a highly eff ective and reliable method of treatment in the group of older patients.

scholarly journals A visualized pulmonary arterial thrombus by using a new  echocardiographic view in an intermediate-risk a cute pulmonary embolism  patient: a case report

2019 ◽  
Author(s):  
Guanyu Mu ◽  
Feixue Li ◽  
Xiaolin Chen ◽  
Bo Zhao ◽  
Guangping Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Acute Pulmonary Embolism ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Pulmonary Angiography ◽  
Normal Blood ◽  
Intermediate Risk ◽  
Normal Blood Pressure

Abstract BackgroundAcute pulmonary embolism (APE) is a life-threatening disease with nonspecific clinical signs and symptoms. Rapid and accurate diagnosis is crucial for the clinical management of patients with acute pulmonary embolism. A new recommended echocardiography view may be of further help in the diagnosis, evaluate the change of the thrombosis and treatment effect.Case presentationWe report a case of a 74-year-old man with a 12-day history of decreased exercise capacity and dyspnoea. The patient was diagnosed intermediate-risk APE as several pulmonary emboli in pulmonary artery were seen in multidetector computed tomographic pulmonary angiography with normal blood pressure and echocardiographic right ventricular overload. And we found a pulmonary artery clot in the right pulmonary artery through transthoracic echocardiography. After 11-days anticoagulation, the patient underwent a reassessment, showed decrease in RV diameter and pulmonary artery thrombus. ConclusionThis case highlights the significant role that echocardiography played in a patient who presented pulmonary embolism with a stable hemodynamic situation and normal blood pressure. The new echocardiographic view could provide correct diagnoses by identifying the clot size and location visually. Knowledge of the echocardiography results of APE would aid the diagnosis.

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 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.

TREATMENT OF ACUTE MASSIVE PULMONARY EMBOLISM WITH INTRAVENOUS VS. INTRAPULMONARY ARTERY ADMINISTERED RECOMBINANT TISSUE-TYPE PLASMINOGEN ACTIVATOR

1987 ◽  
Author(s):  
M Verstraete
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Plasminogen Activator ◽  
Pilot Trial ◽  
Massive Pulmonary Embolism ◽  
Tissue Type ◽  
Major Surgery ◽  
Miller Index ◽  
Tissue Type Plasminogen Activator ◽  
Type Plasminogen Activator

Recombinant tissue-type plasminogen activator (rt-PA) was given to 34 patients with acute massive pulmonary embolism of less than five days and with an angiographic Miller index greater than 15. The regimen was 50 mg rt-PA over 2 hours followed by repeat angiography, and, if the Miller index was judged still to be above 15, by an additional dose of 50 mg over 5 hours. Heparin was given in a bolus of 5000 IU followed by 1000 IU per hour. The rt-PA preparation (Boehringer Ingelheim GmbH, G 11021) contained mainly two-chain rt-PA. The infusion route was at random in a peripheral vein (IV) or in the pulmonary artery (PA). Pulmonary angiographs were assessed blindly by a panel of five radiologists according to the protocol developed by Miller (Br Med J 1971). 19 patients were given rt-PA via the pulmonary artery, 15 patients received rt-PA intravenously. Eleven patients were postoperative (PA 9, mean 13± ]] SD days, IV 4, 7±3 daysSixteen patients (66%) received two infusions (PA 14; IV 8). The Miller index decreased from 25 ± 3 to 22 ± 6 (−12%) in the PA group and from 26 ± 2 to 22 ± 5 (−15%) in the IV group after the first infusion. In the patients who received a second infusion, the Miller index decreased to 16 ± 6 (−38%) after 100 mg in the PA group and to 16±;6 (−38%) in the IV group. The mean pulmonary artery pressure decreased from 30 ± 7 to 22 ± 6 (−27%) and further to 14 ± 5 (−53%) in the PA group and from 29 ± 7 to 22 ± 9 (−24%) after 50 mg and to 13 ± 5 (−55%) after 100 mg in the IV group. All these differences are significant (p < 0.01)Fibrinogen levels dropped 46% from baseline after 50 mg and 66% from baseline after 100 mg. Bleeding occurred in 16 patients, 5 of whom had recent surgery (mean 8 days, range 2-13)This pilot trial indicates that a prolonged infusion of rt-PA over 7 hours (100 mg) is superior to a single infusion over 2 hours (50 mg) and that infusion in the pulmonary artery does not offer a significant clinical benefit over the intravenous route. In case of life-threatening massive pulmonary embolism, treatment with rt-PA could be envisaged as early as from the third day after major surgery

An approach to the surgical treatment of pulmonary embolism

JAMA ◽  
1966 ◽  
Vol 196 (1) ◽  
pp. 11-16 ◽  
Author(s):  
R. W. Frater
Keyword(s):  
Pulmonary Embolism ◽  
Surgical Treatment

Advanced Management Options for Massive and Submassive Pulmonary Embolism

2016 ◽  
Vol 10 (1) ◽  
pp. 30 ◽  
Author(s):  
Sonika Malik ◽  
◽  
Anju Bhardwaj ◽  
Matthew Eisen ◽  
Sanjay Gandhi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Vena Cava ◽  
Right Ventricular Dysfunction ◽  
Hemodynamic Instability ◽  
Adverse Outcomes ◽  
Intermediate Risk ◽  
Management Options ◽  
Vena Cava Filters ◽  
Submassive Pulmonary Embolism ◽  
Risk Patients

Pulmonary embolism (PE) is an important cause of morbidity and mortality and presents with significant diagnostic and therapeutic challenges. Clinical presentation ranges from mild, nonspecific symptoms to syncope, shock, and sudden death. Patients with hemodynamic instability and/ or signs of right ventricular dysfunction are at high risk for adverse outcomes and may benefit from aggressive therapy and support. Therapeutic anticoagulation is indicated in all patients in the absence of contraindications. Thrombolysis should be strongly considered in selected high- and intermediate-risk patients, either by systemic infusion or percutaneous catheter-directed therapy. Other therapeutic modalities, such as vena cava filters and surgical embolectomy, are options for patients who fail or cannot tolerate anticoagulation and/or thrombolysis. This article reviews the assessment and advanced management options for acute PE with focus on high- and intermediate-risk patients.

Extrascleral Filling Using Endoillumination the First Experiencethe

2020 ◽  
pp. 43-49
Author(s):  
V.Y. Markevich ◽  
◽  
T.A. Imshenetskaya ◽  
O.A. Yarmak ◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Silicone Oil ◽  
Subretinal Fluid ◽  
Crystalline Lens ◽  
Vitreous Cavity ◽  
Macular Area ◽  
General Group ◽  
Anatomical Outcome

Purpose. To study the effectiveness of extrascleral filling (ESF) using endoillumination in the surgical treatment of patients with primary rhegmatogenous retinal detachment (RRD). Material and methods. The material for the study was the data of a comprehensive clinical examination and surgical treatment by ESF method using endoillumination in 17 patients (17 eyes) with RRD. In 7 cases (41%), the macular area was involved in the detachment process. In 5 cases (29.4%), local scleral filling was performed. In the remaining 12 cases (70.6%), the local ESF was supplemented with a circling silicone element. Surgical intervention was supplemented by transscleral drainage of subretinal fluid (SRF) in 10 cases (59%) and pneumatic retinopexy with SF6 gas 50% in 8 cases (48%). Results. In the general group of patients, best corrected visual acuity (BCVA) increased from 0.35 to 0.46. In the subgroup of patients with a detached macular area, the positive dynamics is more pronounced, BCVA increased from 0.1 to 0.28. The progression of proliferative vitreoretinopathy caused the recurrence of retinal detachment in two patients (11.8%). Recurrences were diagnosed after 3 and 5 months, respectively. In both cases, a vitrectomy with tamponade of the vitreous cavity with silicone oil 5000 Cst was performed. The percentage of successful anatomical outcome after the first operation in our study was 82%. The percentage of successful achievement of the final anatomical result was 94%. In two cases, additional injection of SF6 gas into the vitreous cavity was required. Conclusion. This type of surgical treatment is an effective method of surgical treatment of patients with RRD. In our study, the successful anatomical outcome after the first operation was recorded in 82% of patients, which correlates with the data of the authors who also used this method (83–92%). Surgeons who performed surgical treatment using this technique in our study note improved workplace ergonomics when visualizing the fundus using an operating microscope and endoillumination compared with indirect ophthalmoscopy. Other teams of authors came to this conclusion as well. In our study, there were no complications associated with the introduction of a light pipe into the vitreous cavity (iatrogenic crystalline lens injury, endophthalmitis), which indicates the safety of this type of surgical treatment.

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