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1.
Medicine (Baltimore) ; 98(51): e18386, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861001

RESUMO

RATIONALE: Pulmonary embolisms (PEs) are caused by emboli, which mostly originate from deep venous thrombi that travel to and suddenly block the pulmonary arteries. The emboli are usually thrombi, and right atrial myxoma emboli are rare. PATIENT CONCERNS: A 55-year-old man presented with shortness of breath and syncope. We proceeded with computed tomography pulmonary angiography (CTPA) and transthoracic echocardiogram (TTE), the results of which suggested that the diagnosis was a right atrial mass. DIAGNOSIS: A definitive diagnosis compatible with a right atrial myxoma (RAM) with tumoral pulmonary emboli after surgical excision was made. INTERVENTION: Right atrial and pulmonary artery embolectomy. OUTCOMES: The patient followed an uneventful course during the 6 years of follow-up after surgery. According to a review of the literature, RAMs are often not diagnosed in a timely manner or even go completely undiagnosed. TTE, transesophageal echocardiography (TEE), CT, magnetic resonance imaging (MRI), and positron emission tomography/computed tomography may be helpful in the preoperative diagnosis. Surgical removal of the masses from the atrium and pulmonary arteries was relatively uneventful. LESSONS: RAMs should be considered unlikely reasons for fatal pulmonary embolisms.


Assuntos
Átrios do Coração/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Mixoma/diagnóstico por imagem , Embolia Pulmonar/etiologia , Angiografia por Tomografia Computadorizada , Ecocardiografia , Átrios do Coração/cirurgia , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Mixoma/patologia , Mixoma/cirurgia , Embolia Pulmonar/cirurgia
2.
Angiol Sosud Khir ; 25(4): 167-172, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855214

RESUMO

Pulmonary haemorrhage is one of the most severe complications of pulmonary endarterectomy. To the most effective methods of combating this potentially fatal complication belongs extracorporeal membrane oxygenation (ECMO). In this article we describe a clinical case report regarding intraoperative use of central veno-arterial ECMO for pulmonary haemorrhage following thromboendarterectomy from the pulmonary arteries. According to the data of some authors, long-term ECMO support (for more than 4 days) may lead to such severe consequences as rethrombosis of pulmonary arteries and impairment of cerebral circulation. In our case we managed to avoid such complications, taking into consideration that the duration of ECMO amounted to 21 days. Resulting from the carried out comprehensive therapeutic measures by the time of discharge from hospital, a significant decrease in pulmonary artery pressure was achieved, with events of residual pulmonary hypertension.


Assuntos
Endarterectomia/efeitos adversos , Oxigenação por Membrana Extracorpórea , Hemorragia/cirurgia , Pneumopatias/cirurgia , Embolia Pulmonar/cirurgia , Hemorragia/etiologia , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/terapia , Pneumopatias/etiologia
3.
Tex Heart Inst J ; 46(3): 172-174, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708697

RESUMO

Treatments for pulmonary embolism are numerous and often complex. Current data on surgical thrombectomy are important but are not readily available. We studied the National Inpatient Sample to evaluate trends in the performance rates and outcomes of surgical thrombectomy in the United States from 2003 through 2014. We think that our findings have meaningful application to the triage and risk stratification of patients who have hemodynamically significant pulmonary embolism.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Embolia Pulmonar/cirurgia , Trombectomia/métodos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida/tendências , Resultado do Tratamento , Estados Unidos/epidemiologia
4.
Isr Med Assoc J ; 21(8): 528-531, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474014

RESUMO

BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare, distinct pulmonary vascular disease, which is caused by chronic obstruction of major pulmonary arteries. CTEPH can be cured by pulmonary endarterectomy (PEA). PEA for CTEPH is a challenging procedure, and patient selection and the perioperative management are complex, requiring significant experience. OBJECTIVES: To describe the establishment of a national CTEPH-PEA center in Israel and present results of surgery. METHODS: In this study, we reviewed the outcomes of PEA in a national referral, multi-disciplinary center for CTEPH-PEA. The center was established by collaborating with a high-volume center in Europe. A multidisciplinary team from our hospital (pulmonary hypertension specialist, cardiac surgeon, cardiac anesthesiologist and cardiac surgery intensivist was trained under the guidance of an experienced team from the European center. RESULTS: A total of 38 PEA procedures were performed between 2008 and 2018. We included 28 cases in this analysis for which long-term follow-up data were available. There were two hospital deaths (7%). At follow-up, median New York Heart Association (NYHA) class improved from III to I (P < 0.0001), median systolic pulmonary pressure decreased from 64 mmHg to 26 mmHg (P < 0.0001), and significant improvements were seen in right ventricular function and exercise capacity. CONCLUSIONS: A national center for performance of a rare and complex surgical procedure can be successfully established by collaboration with a high-volume center and by training a dedicated multidisciplinary team.


Assuntos
Endarterectomia/métodos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/cirurgia , Embolia Pulmonar/complicações , Embolia Pulmonar/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/cirurgia , Encaminhamento e Consulta , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
5.
Rev. bras. cir. plást ; 34(3): 310-314, jul.-sep. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047144

RESUMO

Introdução: A demanda por cirurgia plástica tem aumentado progressivamente, dentre os procedimentos mais frequentes estão as cirurgias de mamas (aumento e redução). Métodos: Estudo retrospectivo de prontuários de pacientes que foram submetidas a mamoplastia redutora e de aumento, no período de janeiro de 2015 a junho de 2018, no Hospital PUC-Campinas. Resultados: Foram realizadas 13 mamoplastias de aumento e 275 mamoplastias redutoras. Das 288 cirurgias realizadas duas (n=2) evoluíram com TEP (tromboembolismo pulmonar). Conclusão: Portanto, a incidência de fenômenos tromboembólicos em mamoplastias de aumento e redutoras mostrou-se baixa no presente estudo, assim como na literatura. Já as pacientes acometidas no estudo eram consideradas de baixo risco para complicação tromboembólica, de acordo com protocolos de profilaxia, devendo-se atentar para tais fenômenos no pós-operatório. Ainda são necessários mais estudos para padronização do uso de medidas de profilaxia do tromboembolismo venoso.


Introduction: The demand for plastic surgery has progressively increased, and breast enlargement and reduction surgeries are among the most frequent procedures. Methods: This retrospective study reviewed the medical records of patients who underwent reduction and augmentation mammoplasty between January 2015 and June 2018 at the PUC-Campinas Hospital. Results: Thirteen augmentation mammoplasties and 275 reduction mammoplasties were performed. Of the 288 patients who underwent surgeries, two patients developed postoperative pulmonary thromboembolism. Conclusion: The incidence of thromboembolic phenomena in augmentation and reduction mammoplasty is low. Patients in this study were considered at low risk for thromboembolic complications. According to prophylaxis protocols, this phenomena should be monitored postoperatively. Further studies are needed to standardize the use of venous thromboembolism prophylaxis measures.


Assuntos
Humanos , Feminino , Adulto , História do Século XXI , Pacientes , Embolia Pulmonar , Cirurgia Plástica , Mama , Registros Médicos , Estudos Retrospectivos , Embolia e Trombose , Trombose Venosa , Pacientes/estatística & dados numéricos , Embolia Pulmonar/cirurgia , Embolia Pulmonar/complicações , Cirurgia Plástica/estatística & dados numéricos , Mama/cirurgia , Registros Médicos/estatística & dados numéricos , Embolia e Trombose/cirurgia , Trombose Venosa/cirurgia , Trombose Venosa/complicações
6.
Medicine (Baltimore) ; 98(28): e16385, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305442

RESUMO

RATIONALE: Invasive thymoma with intraluminal tumor thrombus may cause pulmonary artery thrombus if the tumor thrombus shed off during operation. However, there is no clinical case report focused on such complication. PATIENT CONCERNS: A 40-year-old woman presented with repeated chest pain. DIAGNOSIS: Chest computer tomography showed huge mediastinal mass. Postoperative pathology revealed type B2 and B3 thymoma, with B3 as the main type. INTERVENTIONS: The patient underwent tumor resection through midline sternotomy in our hospital on September 17, 2018. She received emergent pulmonary artery exploration because the tumor thrombus in superior vena cava shed off unexpectedly during operation. Postoperative pulmonary computer tomography angiography showed right pulmonary artery embolism. Then emergent right pulmonary artery embolectomy was performed through lateral thoracic incision on September 29, 2018. OUTCOMES: The patient recovered well after surgery. D-dimer reduced rapidly and returned to normal 1 month after the second operation. LESSONS: Intraluminal tumor thrombus in invasive thymoma patients has a risk of shedding off during operation. Prevention strategy should be made beforehand. Pulmonary artery exploration is necessary once happened.


Assuntos
Complicações Intraoperatórias , Embolia Pulmonar/etiologia , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Adulto , Feminino , Humanos , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/cirurgia , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/cirurgia , Reoperação , Timoma/diagnóstico por imagem , Timoma/patologia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologia
7.
Vnitr Lek ; 65(5): 353-358, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31163968

RESUMO

Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease characterized by a mean pulmonary artery pressure that exceeds 25 mm Hg and is caused by intraluminal thrombi organisation, stenosis and occlusions of pulmonary artery and its branches and peripheral vascular remodelation. It is a chronic complication of acute pulmonary embolism. The obstruction of pulmonary artery branches increases pulmonary vascular resistance (PVR) and this leads to the right ventricular overload and right-sided heart failure. The treatment of choice is surgical pulmonary endarterectomy (PEA), a procedure that is performed in deep hypothermic cardiac arrest. The only center that specializes into the surgical treatment of patients with CTEPH in the Czech Republic is the Complex Cardiovascular Centre at the General Teaching Hospital in Prague. Between years 2004-2017 there were 314 patients opera-ted (including 50 patients from Slovakia, where this treatment is not available). Patients with peripheral type of CTEPH, who are not indicated for operation and also patients with residual pulmonary hypertension after PEA can be indicated for specific vasodilatation therapy. In indicated cases the treatment may involve the balloon angioplasty or lung transplantation.


Assuntos
Hipertensão Pulmonar , Embolia Pulmonar , Doença Crônica , República Tcheca , Endarterectomia , Humanos , Hipertensão Pulmonar/cirurgia , Artéria Pulmonar , Embolia Pulmonar/complicações , Embolia Pulmonar/cirurgia , Eslováquia , Resultado do Tratamento
8.
Tex Heart Inst J ; 46(2): 115-119, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31236075

RESUMO

Venous thromboembolism is a leading cause of cardiovascular death. Historically, surgical intervention has been associated with high morbidity rates. Pharmacologic therapy alone can be inadequate for patients with substantial hemodynamic compromise, so minimally invasive procedures are being developed to reduce clot burden. We describe our initial experience with using the AngioVac system to remove thromboemboli percutaneously. We reviewed all suction thromboembolectomy procedures performed at our institution from March 2013 through August 2015. The main indications for the procedure were failed catheter-directed therapy, contraindication to thrombolysis, bleeding-related complications, and clot-in-transit phenomena. We collected details on patient characteristics, procedural indications, thrombus location, hemodynamic values, cardiac function, pharmacologic support, and survival to discharge from the hospital. The Wilcoxon signed-rank test was used for statistical analysis. Thirteen patients (mean age, 56 ± 15 yr; 10 men) underwent suction thromboembolectomy; 10 (77%) survived to hospital discharge. The median follow-up time was 74 days (interquartile range [IQR], 23-221 d). Preprocedurally, 8 patients (62%) had severe right ventricular dysfunction; afterwards, 11 (85%) had normal function or mild-to-moderate dysfunction, and only 2 (17%) had severe dysfunction (P=0.031). Percutaneous suction thromboembolectomy, a promising therapeutic option for patients, appears to be safe, and we found it to be associated with improved right ventricular function.


Assuntos
Ventrículos do Coração/fisiopatologia , Artéria Pulmonar/cirurgia , Embolia Pulmonar/cirurgia , Trombectomia/métodos , Função Ventricular Direita/fisiologia , Feminino , Seguimentos , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/fisiopatologia , Estudos Retrospectivos , Sucção/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
Ann Thorac Surg ; 108(4): 1183-1188, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31055039

RESUMO

BACKGROUND: Pulmonary embolism is a significant cause of morbidity and mortality. An important subpopulation of patients presenting with acute pulmonary embolism have concurrent undiagnosed chronic thromboembolic disease. We sought to further characterize this subpopulation, specifically in a cohort of patients referred for surgical pulmonary embolectomy. METHODS: A retrospective review of all patients requiring surgical pulmonary embolectomy at a single center (2013-2017) was performed. Chart review and blinded examination of presenting computed tomographic pulmonary angiograms were done to identify clinical and radiographic features associated with acute on chronic disease. A predictive tool utilizing readily accessible variables was then constructed for risk stratification. RESULTS: A total of 90 patients were identified for analysis; 34 were treated by specifically trained pulmonary thromboendarterectomy surgeons. Twelve patients in the subgroup treated by pulmonary thromboendarterectomy surgeons were found to have acute on chronic disease confirmed by intraoperative endarterectomized specimen. On univariate analysis, degree of pulmonary artery and inferior vena cava dilation and duration of respiratory symptoms were statistically significant variables. Severe right ventricular hypertrophy, elevation in N-terminal pro-B-type natriuretic peptide, and unprovoked etiology were also associated with acute on chronic disease. A predictive tool weighing the presence of these features was created allowing for stratification into low-, moderate-, and high-risk patients. The positive predictive value of a high-risk score was 100%. CONCLUSIONS: In this cohort, the prevalence of acute on chronic thromboembolic disease was greater than 1 in 3. Readily available clinical and radiographic features were used to create a predictive tool for risk stratification.


Assuntos
Embolectomia , Embolia Pulmonar/complicações , Embolia Pulmonar/cirurgia , Tromboembolia/epidemiologia , Doença Aguda , Doença Crônica , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Embolia Pulmonar/diagnóstico , Estudos Retrospectivos , Tromboembolia/diagnóstico
10.
Ann Thorac Surg ; 108(4): 1154-1161, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31075248

RESUMO

BACKGROUND: Pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) is technically demanding. We tried to identify the predictors for short- and long-term outcomes after PEA for CTEPH with aggressive use of pulmonary vasodilators, including epoprostenol sodium. METHODS: From 2005 to 2013, 122 CTEPH patients, whose preoperative mean pulmonary artery pressure (mPAP) was 47 ± 10 mm Hg and pulmonary vascular resistance was 847 ± 373 dynes/s/cm5, underwent PEA with hypothermic circulatory arrest. Before PEA, all patients underwent pulmonary vasodilator therapy, including epoprostenol sodium of 2 to 6 ng/kg/min. We collected the perioperative and follow-up data retrospectively to identify the predictors for early and late outcomes after PEA. RESULTS: In-hospital mortality was 7.4% (n = 9). Predictors for in-hospital death were age older than 65 years and New York Heart Association Functional Classification IV. Among the 113 PEA survivors, the mPAP and pulmonary vascular resistance significantly decreased. After the median follow-up of 6.8 years, the overall survival rates were 91.8%, 89.2%, 89.2%, 89.2%, and 86.1%, and the cardiac events-free rates were 100%, 98.1%, 95.8%, 85.5%, and 49.0%, at 1, 3, 5, 7, and 10 years, respectively, in the Kaplan-Meier model. A multivariate Cox proportional hazard model identified postoperative mPAP exceeding 30 mm Hg as the only predictor for late cardiac events. CONCLUSIONS: Early and late outcomes of PEA for CTEPH with perioperative aggressive pulmonary vasodilator treatment seem satisfactory. However, residual pulmonary hypertension remains challenging to achieve further improvement of late outcomes.


Assuntos
Endarterectomia , Hipertensão Pulmonar/terapia , Embolia Pulmonar/cirurgia , Adulto , Idoso , Anti-Hipertensivos/uso terapêutico , Doença Crônica , Epoprostenol/uso terapêutico , Feminino , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/mortalidade , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/complicações , Embolia Pulmonar/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Resistência Vascular , Vasodilatadores/uso terapêutico , Adulto Jovem
11.
Intern Med ; 58(15): 2139-2144, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30996169

RESUMO

Objective Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disease that leads to right-sided heart failure with electrocardiographic abnormalities. There are only a few reports about the effects of balloon pulmonary angioplasty for CTEPH on the electrocardiographic criteria of right ventricular hypertrophy. To determine the effect of balloon angioplasty on electrocardiography in patients with CTEPH. Methods We evaluated electrocardiograms in 19 patients (mean age, 64±10 years) who underwent balloon pulmonary angioplasty. Results We compared the hemodynamic parameters after balloon pulmonary angioplasty. The mean pulmonary artery pressure was decreased (p<0.001), and the cardiac index was increased (p=0.025) after balloon pulmonary angioplasty. The level of brain natriuretic peptide was decreased (p=0.001) after balloon pulmonary angioplasty (p<0.001). We applied 15 criteria for right ventricular hypertrophy to the patients, according to the American Heart Association recommendations of the electrocardiogram, after balloon pulmonary angioplasty. Among the criteria, the numbers of patients who met the criteria of deep S in V6 (p=0.005) and max R in V1, 2+max S in I, aVL-S in V1 (p=0.046) were significantly decreased after balloon pulmonary angioplasty. The mean numbers regarding the right ventricular hypertrophic criteria in each patient were significantly decreased after balloon pulmonary angioplasty (4.8±2.6 to 3.1±2.5, p=0.003). Conclusion In addition to improvement in hemodynamics, improvement in right ventricular hypertrophy was also observed using the electrocardiographic criteria in patients with CTEPH after balloon pulmonary angioplasty, suggesting that we should pay more attention to these changes.


Assuntos
Angioplastia com Balão/efeitos adversos , Eletrocardiografia/métodos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/cirurgia , Hipertrofia Ventricular Direita/fisiopatologia , Embolia Pulmonar/complicações , Embolia Pulmonar/cirurgia , Idoso , Feminino , Hemodinâmica/fisiologia , Humanos , Japão , Masculino , Pessoa de Meia-Idade
12.
J Card Surg ; 34(6): 428-434, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31017313

RESUMO

BACKGROUND: Pulmonary endarterectomy (PEA) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH) but can result in respiratory and cardiac complications that may require extracorporeal membrane oxygenation (ECMO). We reviewed our experience with ECMO in patients undergoing PEA. METHODS AND RESULTS: Between January 2012 and August 2015, 35 patients underwent PEA for CTEPH. In all, four patients (11%) required veno-arterial (V-A) ECMO support due to severe cardiac and respiratory failure, including severe reperfusion pulmonary edema and persistent pulmonary hypertension. No significant differences in preoperative characteristics were found between patients who required ECMO and those who did not require ECMO. ECMO support was associated with a significantly higher incidence of postoperative respiratory complications, a longer intensive care unit stay, increased in-hospital mortality, residual pulmonary hypertension, and postoperative balloon pulmonary angioplasty (BPA). The postoperative mean pulmonary artery pressure and pulmonary vascular resistance were significantly higher in patients requiring ECMO. All patients requiring ECMO were successfully weaned off ECMO support (100%), and three of them were discharged from the hospital alive (75%). CONCLUSIONS: Patients with CTEPH may benefit from ECMO after PEA for cardiac and respiratory complications. A prompt decision to use V-A ECMO is critical for a successful outcome in these patients.


Assuntos
Endarterectomia/métodos , Oxigenação por Membrana Extracorpórea/métodos , Insuficiência Cardíaca/terapia , Hipertensão Pulmonar/cirurgia , Complicações Pós-Operatórias/terapia , Embolia Pulmonar/cirurgia , Insuficiência Respiratória/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Resultado do Tratamento
13.
Am J Cardiol ; 123(11): 1874-1877, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30952380

RESUMO

Retrospective cohort studies using administrative data from national databases or a registry suggest that there are subcategories of stable patients with acute pulmonary embolism who would show a reduced mortality with an inferior vena cava (IVC) filter in addition to anticoagulants. These subcategories are those who underwent pulmonary embolectomy, receiving thrombolytic therapy, suffering recurrent pulmonary embolism while on treatment, hospitalized with solid malignant tumors if aged >60 years, hospitalized with chronic obstructive pulmonary disease (COPD) if aged >50 years, and very elderly (aged >80 years). The following is a review of these studies. It is important to be circumspect in inferring a lower mortality with IVC filters based on comparative effectiveness research that uses national observational data. On the other hand, the likelihood of a randomized controlled trial in any of these subcategories of stable patients is remote. Whether patients are better served by inserting an IVC filter on the basis of retrospective cohort studies, or by withholding IVC filters until a randomized controlled trial can be obtained is a matter for consideration.


Assuntos
Embolia Pulmonar/cirurgia , Filtros de Veia Cava , Veia Cava Inferior , Humanos , Resultado do Tratamento
15.
J Card Surg ; 34(5): 312-317, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30908728

RESUMO

BACKGROUND AND OBJECTIVES: Atrial arrhythmias (AAs) are common after cardiac surgeries including pulmonary thromboendarterectomy (PTE). This study was done to identify patients at highest risk of developing post-PTE AA and their length of stay (LOS). METHODS: We reviewed 521 consecutive patients referred to University of California San Diego (UCSD) for PTE and examined their demographics as well as their baseline pulmonary hemodynamics to determine risk factors for AA. RESULTS: Overall, 24.2% of patients developed an AA after PTE. Patients who developed AA had a significantly longer Intensive Care Unit (ICU) LOS (median: 5 vs 3 days, P < 0.001) and postoperative LOS (median: 14 vs 9 days; P < 0.001). Patients who developed AA were more frequently male (63.2% male, P = 0.003), older (mean age 60.8 vs 50.7 years, P < 0.001), had a prior history of atrial fibrillation (80.2% of those who developed AA) and were more likely to have undergone concomitant Coronary Artery Bypass Graft (12.7% vs 6.6%, P = 0.028). Compared to those who did not develop AA, the cardiopulmonary bypass time was longer among those who developed AA (261.6 vs 253.8 minutes, P = 0.027). In a multivariate logistic regression model, the preoperative variables that predicted AA were age (odds ratio [OR], 1.058 per year, 95% confidence interval [CI]: 1.038-1.078), male sex (OR, 1.68, 95% CI: 1.06-2.64), prior AA (OR, 2.52, 95% CI: 1.23-5.15) and baseline right atrial pressure (OR, 1.039 per mm Hg, 95% CI: 1.000-1.079). While mortality rates were similar, patients who developed AA had more bleeding complications and more postoperative delirium. CONCLUSIONS: AA is common after PTE surgery. The strongest risk factors for AA after PTE included the previous history of AA, age and male sex. Development of AA was associated with longer lengths of stay and more postoperative complications.


Assuntos
Arritmias Cardíacas/epidemiologia , Endarterectomia , Complicações Pós-Operatórias/epidemiologia , Embolia Pulmonar/cirurgia , Adulto , Fatores Etários , Idoso , Arritmias Cardíacas/etiologia , Fibrilação Atrial/complicações , Ponte Cardiopulmonar , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Risco , Fatores de Risco , Fatores Sexuais
16.
Scand Cardiovasc J ; 53(2): 98-103, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30919668

RESUMO

BACKGROUND: Acute massive pulmonary embolism is often a life-threatening condition and should be treated immediately. The aim of this study was to investigate risk factors and clinical outcomes of patients undergoing emergency pulmonary embolectomy for acute massive pulmonary embolism. METHODS: We evaluated 49 patients undergoing emergency pulmonary embolectomy in our institution between 1995 and 2015, retrospectively. We reviewed preoperative conditions and risk factors, surgical complications, postoperative courses, predictors of mortality and long-term survival. RESULTS: At the time of presentation, the median patients' age was 58 years. Preoperatively, seven (14%) individuals had cardiac arrest and required cardiopulmonary resuscitation. At the time of surgery, other 23 (47%) patients presented with cardiogenic shock. The most common risk factor for development of pulmonary embolism was major surgery in the last 30 days (29%, n = 14). Five (10%) patients received systemic thrombolysis preoperatively. The median cardiopulmonary bypass (CPB) time was 82 minutes. The median length of stay in the intensive care unit and in hospital were 1 and 14 days, respectively. Postoperative complications included revision as a consequence of mediastinal bleeding (6%, n = 3), stroke (2%, n = 1), and acute renal failure requiring temporary dialysis (4%, n = 2). The 30-day mortality was 29% (n = 14) with four (8%) cases of death during the surgery. The one-, five- and 15-year survival rates were 65%, 63%, and 57%, respectively. CONCLUSION: Pulmonary embolectomy can be performed in high-risk patients with massive pulmonary embolism with acceptable clinical outcome and good long-term survival.


Assuntos
Embolectomia , Embolia Pulmonar/cirurgia , Doença Aguda , Adulto , Idoso , Embolectomia/efeitos adversos , Embolectomia/mortalidade , Emergências , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/mortalidade , Embolia Pulmonar/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
17.
J Card Surg ; 34(4): 170-180, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30843269

RESUMO

BACKGROUND: AngioVac is a new device for filtering intravascular thrombi and emboli. Publications on the device are limited and underpowered to objectively estimate its safety and efficacy. We aimed to overcome this by performing a meta-analysis on the results of AngioVac for treating venous thromboses and endocardial vegetations. METHODS: A systematic literature review was performed to identify all articles reporting cardiac vegetation and/or thrombosis extraction using AngioVac. Endpoints were successful removal, operative mortality, conversion to open surgery, hospital stay, recurrent thromboembolism, and follow-up mortality. Random effect model was used, and pooled event rates (PERs) and incidence rate (IR) were calculated. RESULTS: A total of 42 studies with 182 patients (81 vegetation and 101 thrombosis) were included. Overall mean follow-up times were 3.1 and 0.7 years in vegetation and thrombosis patients, respectively. The PERs for successful removal were 74.5 (confidence interval [CI]: 48.2-90.2), 80.5 (CI: 70.0-88.0), and 32.4 (CI: 17.0-52.8) in vegetation, right atrial/caval venous thrombi, and pulmonary emboli (PE) patients, respectively. The PERs for operative mortalities were 14.6 (CI: 7.7-25.8), 14.8 (CI: 8.5-24.5), and 32.3 (CI: 15.1-56.3), respectively. The PERs for conversion to open surgery were 25.0 (CI: 9.3-51.9) and 12.3 (CI: 5.4-25.6) in vegetation and thrombosis patients, respectively. The IR of recurrent thromboembolism was 0.18 per person per year (PPY) (CI: 0.00-14.69) in vegetation and 0.19 PPY (CI: 0.08-0.48) in thrombosis patients. IR of follow-up mortality was 0.37 PPY (CI: 0.11-1.21) in thrombosis patients. CONCLUSIONS: AngioVac is a viable option for extracting right-sided vegetations and right atrial/caval venous thrombi. Rates of successful extraction and mortality are significantly worse for PE.


Assuntos
Dispositivos de Proteção Embólica , Endocardite Bacteriana/cirurgia , Embolia Pulmonar/cirurgia , Trombectomia/instrumentação , Trombose Venosa/cirurgia , Bases de Dados Bibliográficas , Endocardite Bacteriana/mortalidade , Seguimentos , Humanos , Embolia Pulmonar/mortalidade , Trombectomia/métodos , Resultado do Tratamento , Trombose Venosa/mortalidade
18.
Rev. esp. cardiol. (Ed. impr.) ; 72(3): 224-232, mar. 2019. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-182644

RESUMO

Introducción y objetivos: Se consolida la angioplastia con balón de arterias pulmonares (ABAP) en la hipertensión pulmonar tromboembólica crónica (HPTEC) no operable. El procedimiento se ha perfeccionado y han disminuido las complicaciones. Se analizan como objetivo primario los resultados y las complicaciones del primer programa nacional de ABAP. Métodos: Estudio prospectivo, unicéntrico y observacional que incluyó a todos los pacientes con HPTEC no quirúrgica tratados mediante ABAP desde mayo de 2013 hasta febrero de 2017. Se analizaron la mejoría clínica y hemodinámica, el edema de reperfusión y la mortalidad. Resultados: Se realizaron 156 sesiones de ABAP en 46 pacientes. Se redujeron las resistencias vasculares pulmonares un 44% (10,1 ± 4,9 frente a 5,6 ± 2,2 UW; p < 0,001) y la presión arterial pulmonar media un 23,6% (49,5 ± 12 frente a 37,8 ± 9 mmHg; p < 0,001); el índice cardiaco aumentó un 17,1% (2,3 frente a 2,7 l/min/m2; p = 0,002); las cifras de la fracción aminoterminal del propéptido natriurético cerebral se redujeron el 79,2% (1.233 ± 1.327 frente a 255,5 ± 318 pg/dl; p < 0,001), y la distancia recorrida en la prueba de 6 min de marcha aumentó 74 m (394 frente a 468 m; p = 0,001). Apareció edema de reperfusión en 9 procedimientos (5,8%), y falleció 1 paciente (mortalidad, 2,1%). Conclusiones: El perfeccionamiento actual de la ABAP en pacientes con HPTEC no operable la convierte en una técnica eficaz y segura que mejora el perfil hemodinámico, la clase funcional y los biomarcadores, con baja incidencia de complicaciones graves y mortalidad periprocedimento


Introduction and objectives: Balloon pulmonary angioplasty (BPA) for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) is becoming widely accepted. Procedural refinement has reduced complications. Our primary objective was to analyze the results and complications of the first national BPA program. Methods: Observational, prospective series that included all consecutive BPA procedures in inoperable CTEPH patients between May 2013 and February 2017 performed at a single institution. We analyzed clinical and hemodynamic improvement, reperfusion pulmonary edema, and mortality. Results: We performed 156 BPA sessions in 46 patients. Pulmonary vascular resistance was reduced by 44% (10.1 ± 4.9 vs 5.6 ± 2.2 WU; P < .001) and mean pulmonary arterial pressure by 23.6% (49.5 ± 12 vs 37.8 ± 9 mmHg; P < .001); cardiac index rose by 17.1% (2.3 vs 2.7 L/min/m2; P = .002), N-terminal pro-B-type natriuretic peptide levels were reduced by 79.2% (1233 ± 1327 vs 255.5 ± 318 pg/dL; P < .001) and the 6-minute walk test distance improved by 74 meters (394 vs 468 m; P = .001). Reperfusion pulmonary edema developed after 9 interventions (5.8%) and 1 patient died (mortality 2.1%). Conclusions: Due to its current refinement, BPA has become a safe and effective treatment for inoperable CTEPH that improves hemodynamics, functional status, and biomarkers with a low rate of severe periprocedural complications and mortality


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Angioplastia com Balão/métodos , Hipertensão Pulmonar/cirurgia , Embolia Pulmonar/cirurgia , Artéria Pulmonar/cirurgia , Estudos Prospectivos , Traumatismo por Reperfusão/epidemiologia
20.
J Card Surg ; 34(4): 202-204, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30740775

RESUMO

We report a case of thromboembolism-in-transit through a patent foramen ovale that could cause systemic embolism in a patient with pulmonary embolism. An accurate and quick diagnosis by transthoracic echocardiography and computed tomography allowed emergent surgical thromboembolectomy to be performed without complications. Integral diagnostic workup should be performed in case of acute pulmonary thromboembolism whether the patient is hemodynamically stable or not.


Assuntos
Ecocardiografia , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/cirurgia , Trombectomia , Tomografia Computadorizada por Raios X , Doença Aguda , Adulto , Emergências , Forame Oval Patente , Humanos , Masculino , Embolia Pulmonar/fisiopatologia , Tromboembolia/diagnóstico por imagem , Tromboembolia/cirurgia , Resultado do Tratamento
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