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1.
Cardiol Clin ; 40(1): 103-114, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34809911

RESUMO

Chronic thromboembolic pulmonary hypertension is a distinct form of pulmonary hypertension characterized by the nonresolution of thrombotic material in the pulmonary tree; whenever feasible and safe, first-line treatment should be pulmonary thromboendarterectomy. In patients who are not operative candidates, balloon pulmonary angioplasty (BPA) has emerged as an effective treatment modality that results in improvements in functional class, symptoms, hemodynamics, 6-minute walk distance, and right ventricular and pulmonary artery mechanics. Careful attention to procedural technique and rapid identification and treatment of complications are critical for a successful BPA program.


Assuntos
Angioplastia com Balão , Hipertensão Pulmonar , Embolia Pulmonar , Doença Crônica , Endarterectomia , Humanos , Hipertensão Pulmonar/terapia , Artéria Pulmonar , Embolia Pulmonar/complicações , Embolia Pulmonar/terapia , Resultado do Tratamento
2.
JAAPA ; 35(1): 21-27, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34908560

RESUMO

ABSTRACT: Chronic thromboembolic pulmonary hypertension (CTEPH) remains significantly underdiagnosed in patients with a history of pulmonary embolism. These patients complain of persistent shortness of breath and present with hypoxemia despite proper anticoagulation. Further investigation reveals evidence of right ventricular dysfunction on echocardiogram, which progresses to right heart failure. CTEPH is associated with a significant increase in patient morbidity and mortality if left untreated. This article offers an approach for the timely recognition of this condition, in addition to suggesting a management protocol with an emphasis on the role of interventional radiology and balloon pulmonary angioplasty.


Assuntos
Angioplastia com Balão , Insuficiência Cardíaca , Hipertensão Pulmonar , Embolia Pulmonar , Doença Crônica , Ecocardiografia , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/terapia , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/complicações , Embolia Pulmonar/terapia
3.
Tuberk Toraks ; 69(4): 469-476, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34957740

RESUMO

Introduction: The leading cause of mortality in pulmonary embolism (PE) is hypoxemic respiratory failure. The aim of this study was to compare the efficacy of high-flow nasal cannula (HFNC) and conventional nasal cannula (CNC) oxygen therapy in PE patients with hypoxemia. Materials and Methods: Fifty-eight patients with a PaO2/FIO2 ratio below 300 who were admitted to the emergency department with acute respiratory distress and followed up in our intensive care unit due to PE between March and October 2019 were included in the study. One group (n= 29) received HFNC oxygen therapy and the other group (n= 29) received CNC oxygen therapy. Result: Arterial blood gas analysis showed no significant differences in baseline SpO2 and PaO2 between the HFNC and CNC groups, whereas both values were significantly higher in the HFNC group starting at 1 hour (PaO2: p= .01, p= .001, p= .001; SpO2: p= .009, p= .005, p= .002). Among massive PE patients with contraindications for thrombolytic therapy, there was no significant difference between the HFNC and CNC groups in baseline SpO2, PaO2, or respiratory rate, but those who received HFNC therapy had significant higher SpO2 starting at 15 minutes (p= .004 for all), significantly higher PaO2 starting at 1 hour (p= .01, p= .001, p= .001), and significantly lower respiratory rate starting at 30 minutes (p= .003, p= .001, p= .001, p= .002, p= .002). Conclusions: In patients presenting with PE and hypoxemic respiratory failure, HFNC oxygen therapy was more effective on both vital signs and arterial blood gas parameters compared to conventional oxygen therapy and can be used safely as primary treatment.


Assuntos
Ventilação não Invasiva , Embolia Pulmonar , Insuficiência Respiratória , Cânula , Humanos , Oxigênio , Embolia Pulmonar/complicações , Embolia Pulmonar/terapia , Insuficiência Respiratória/terapia
5.
Rev Med Suisse ; 17(760): 2034-2037, 2021 Nov 24.
Artigo em Francês | MEDLINE | ID: mdl-34817941

RESUMO

Pulmonary tumor embolism is characterized by the occlusion of pulmonary vessels by tumor clots, which can be found in the proximal arteries (macro-embolism) or the small vessels (micro-embolism). The clinical presentation is mainly a progressive dyspnea associated with pulmonary hypertension and subacute cor pulmonale. The diagnosis is difficult, mostly made post-mortem. It is rarely obtained through a combination of multiple diagnostic tests (chest CT, ventilation-perfusion scanning, pulmonary artery cytology, biopsy). Treatment is based on the one of the underlying cancer. The prognosis is poor, and patients usually die within weeks to months. It is a rare cause of pulmonary hypertension that must be considered even without a prior oncological diagnosis.


Assuntos
Neoplasias Pulmonares , Células Neoplásicas Circulantes , Embolia Pulmonar , Doença Cardiopulmonar , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Artéria Pulmonar , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia
6.
Am J Case Rep ; 22: e933427, 2021 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-34793412

RESUMO

BACKGROUND There are no guidelines providing an algorithmic approach for the management of right atrial thrombi, to date, owing to a lack of strong supporting studies. In this case series, we describe 2 cases of high-risk patients with massive right atrial thrombi who had different outcomes. CASE REPORT Case 1: A 62-year-old man with ischemic cardiomyopathy and atrial fibrillation, who was on a permanent pacemaker for sick sinus syndrome and was noncompliant with medication for 2 years, presented to the Emergency Department for evaluation of a 2-month history of progressive shortness of breath and swollen neck veins. A cardiac ultrasound confirmed a large right atrial thrombus, and a computed tomography (CT) pulmonary angiogram was negative for pulmonary emboli. He was managed with a heparin infusion and thrombolytic therapy with favorable evolution. Case 2: A 66-year-old man, with a past medical history of nonischemic cardiomyopathy, atrial fibrillation, deep venous thrombosis, and pulmonary emboli a year earlier, presented to an urgent care unit with sudden onset of shortness of breath. A cardiac ultrasound confirmed a large right atrial thrombus, and a CT pulmonary angiogram confirmed bilateral pulmonary emboli. He was managed with a heparin infusion and EkoSonic endovascular system therapy. He subsequently needed venoarterial extracorporeal membrane oxygenation for cardiopulmonary resuscitation and underwent mechanical aspiration thrombectomy. The patient's evolution was unfavorable. CONCLUSIONS In the absence of an evidence-based guideline to approach right atrial thrombi, management should be individualized for each patient, based on the type of thrombi, hemodynamic status, and presence or absence of associated pulmonary emboli.


Assuntos
Cardiopatias , Embolia Pulmonar , Tromboembolia , Trombose , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/terapia , Terapia Trombolítica , Trombose/tratamento farmacológico
7.
Am J Cardiol ; 161: 102-107, 2021 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-34794606

RESUMO

Multidisciplinary Pulmonary Embolism Response Teams (PERTs) may improve the care of patients with a high risk of pulmonary embolism (PE). The impact of a PERT on long-term mortality has never been evaluated. An observational analysis was conducted of 137 patients before PERT implementation (between 2014 and 2015) and 231 patients after PERT implementation (between 2016 and 2019), presenting to the emergency department of an academic medical center with submassive and massive PE. The primary outcome was 6-month mortality, evaluated by univariate and multivariate analyses. PERT was associated with a sustained reduction in mortality through 6 months (6-month mortality rates of 14% post-PERT vs 24% pre-PERT, unadjusted hazard ratio of 0.57, Relative Risk Reduction of 43%, p = 0.025). There was a reduced length of stay following PERT implementation (9.1 vs 6.5 days, p = 0.007). Time from triage to a diagnosis of PE was independently predictive of mortality, and the risk of mortality was reduced by 5% for each hour earlier that the diagnosis was made. In conclusion, this study is the first to demonstrate an association between PERT implementation and a sustained reduction in 6-month mortality for patients with high-risk PE.


Assuntos
Centros Médicos Acadêmicos , Serviço Hospitalar de Emergência , Equipe de Assistência ao Paciente/normas , Embolia Pulmonar/terapia , Terapia Trombolítica/normas , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/mortalidade , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
8.
Artigo em Inglês | MEDLINE | ID: mdl-34699704

RESUMO

Research shows that the presence of cancer increases the likelihood of developing venous thromboembolism (pulmonary thromboembolism and deep vein thrombosis) from as much as fourfold up to sevenfold. It is imperative that after early diagnosis we treat cancer-associated thrombosis with grave seriousness in order to reduce its morbidity and mortality. We present 14 case reports of patients with cancer-associated thrombosis including thrombosis related to malignant hemopathies.


Assuntos
Neoplasias , Embolia Pulmonar , Trombose , Tromboembolia Venosa , Humanos , Neoplasias/complicações , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Embolia Pulmonar/terapia , Fatores de Risco , Trombose/diagnóstico por imagem , Trombose/epidemiologia , Trombose/etiologia , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia
11.
Cardiol Clin ; 39(4): 551-566, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34686267

RESUMO

Venous thromboembolism (VTE), encompassing pulmonary embolism (PE) and deep vein thrombosis (DVT), is encountered commonly. Acute PE may present as a high-risk cardiovascular emergency, and acute DVT can cause acute and chronic vascular complications. The goal of this review is to ensure that cardiologists are comfortable managing VTE-including risk stratification, anticoagulation therapy, and familiarity with primary reperfusion therapy. Clinical assessment and determination of degree of right ventricular dysfunction are critical in initial risk stratification of PE and determination of parenteral versus oral anticoagulation therapy. Direct oral anticoagulants have emerged as preferred first-line oral anticoagulation strategy in VTE scenarios.


Assuntos
Cardiologistas , Embolia Pulmonar , Tromboembolia Venosa , Trombose Venosa , Anticoagulantes/uso terapêutico , Humanos , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/terapia , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia
12.
JAMA ; 326(13): 1277-1285, 2021 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-34609451

RESUMO

Importance: Active search for pulmonary embolism (PE) may improve outcomes in patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD). Objective: To compare usual care plus an active strategy for diagnosing PE with usual care alone in patients hospitalized for COPD exacerbation. Design, Setting, and Participants: Randomized clinical trial conducted across 18 hospitals in Spain. A total of 746 patients were randomized from September 2014 to July 2020 (final follow-up was November 2020). Interventions: Usual care plus an active strategy for diagnosing PE (D-dimer testing and, if positive, computed tomography pulmonary angiogram) (n = 370) vs usual care (n = 367). Main Outcomes and Measures: The primary outcome was a composite of nonfatal symptomatic venous thromboembolism (VTE), readmission for COPD, or death within 90 days after randomization. There were 4 secondary outcomes, including nonfatal new or recurrent VTE, readmission for COPD, and death from any cause within 90 days. Adverse events were also collected. Results: Among the 746 patients who were randomized, 737 (98.8%) completed the trial (mean age, 70 years; 195 [26%] women). The primary outcome occurred in 110 patients (29.7%) in the intervention group and 107 patients (29.2%) in the control group (absolute risk difference, 0.5% [95% CI, -6.2% to 7.3%]; relative risk, 1.02 [95% CI, 0.82-1.28]; P = .86). Nonfatal new or recurrent VTE was not significantly different in the 2 groups (0.5% vs 2.5%; risk difference, -2.0% [95% CI, -4.3% to 0.1%]). By day 90, a total of 94 patients (25.4%) in the intervention group and 84 (22.9%) in the control group had been readmitted for exacerbation of COPD (risk difference, 2.5% [95% CI, -3.9% to 8.9%]). Death from any cause occurred in 23 patients (6.2%) in the intervention group and 29 (7.9%) in the control group (risk difference, -1.7% [95% CI, -5.7% to 2.3%]). Major bleeding occurred in 3 patients (0.8%) in the intervention group and 3 patients (0.8%) in the control group (risk difference, 0% [95% CI, -1.9% to 1.8%]; P = .99). Conclusions and Relevance: Among patients hospitalized for an exacerbation of COPD, the addition of an active strategy for the diagnosis of PE to usual care, compared with usual care alone, did not significantly improve a composite health outcome. The study may not have had adequate power to assess individual components of the composite outcome. Trial Registration: ClinicalTrials.gov Identifier: NCT02238639.


Assuntos
Doença Pulmonar Obstrutiva Crônica/complicações , Embolia Pulmonar/diagnóstico , Tromboembolia Venosa , Idoso , Causas de Morte , Angiografia por Tomografia Computadorizada/estatística & dados numéricos , Intervalos de Confiança , Progressão da Doença , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hemorragia/etiologia , Hospitalização , Humanos , Masculino , Readmissão do Paciente , Doença Pulmonar Obstrutiva Crônica/terapia , Embolia Pulmonar/sangue , Embolia Pulmonar/etiologia , Embolia Pulmonar/terapia , Recidiva , Espanha , Resultado do Tratamento
14.
G Ital Cardiol (Rome) ; 22(10): 781-792, 2021 Oct.
Artigo em Italiano | MEDLINE | ID: mdl-34570112

RESUMO

Multiple progresses have been achieved in pulmonary vascular diseases in the last decades, including the areas of pulmonary hypertension and pulmonary thromboembolic disease. The increase in knowledge has been accomplished in pathophysiological, clinical and treatment domains and has included as examples the discovery of gene mutations related to the hereditary forms of pulmonary arterial hypertension and the proposals of personalized treatment algorithms in patients with acute pulmonary embolism, chronic thromboembolic pulmonary hypertension and pulmonary arterial hypertension, validated in this specific area by more than 45 randomized controlled trials. The diagnostic processes have been refined, increasing the awareness that appropriate and precise diagnosis is essential for the optimal treatment strategy. The drugs approved for pulmonary arterial hypertension are recommended in this group and in specific patients with chronic thromboembolic pulmonary hypertension but are contraindicated in patients with pulmonary hypertension due to left heart and lung diseases. In pulmonary vascular diseases, the therapy cannot be considered as a simple prescription of medications and interventions but is a complex strategy which includes baseline patients' risk stratification, initial therapy, long-term follow-up and treatment adjustments when required. Today, computed tomography pulmonary artery angiography is the gold standard for diagnosis in both acute pulmonary embolism and chronic thromboembolic pulmonary hypertension. In this last condition, the combination with data derived from the right heart catheterization and the traditional pulmonary artery angiography, allows to a team of experts to decide if the patient is a candidate to surgical pulmonary endarterectomy or to percutaneous pulmonary artery balloon angioplasty which may improve symptoms, quality of life and prognosis.


Assuntos
Angioplastia com Balão , Hipertensão Pulmonar , Embolia Pulmonar , Doença Crônica , Endarterectomia , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/terapia , Artéria Pulmonar , Embolia Pulmonar/terapia , Qualidade de Vida
15.
Curr Opin Cardiol ; 36(6): 704-710, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34508032

RESUMO

PURPOSE OF REVIEW: The aim of this study is to summarize currently available catheter-based therapies in acute and chronic pulmonary embolic disease. RECENT FINDINGS: Catheter-based therapies to treat acute pulmonary embolism and its sequelae such as chronic thromboembolic pulmonary hypertension (CTEPH) are emerging as the next frontier within interventional cardiology. However, the true benefit of these catheter-based therapies in intermediate-risk and high-risk pulmonary embolism and CTEPH remains unclear. The current evidence supporting such interventions comes primarily from small single-arm studies in acute pulmonary embolism and case series in CTEPH. SUMMARY: Appropriately powered randomized controlled trials with meaningful clinical outcomes as endpoints are needed to elucidate the true benefit of catheter-based therapies in pulmonary embolism compared with other treatment modalities such as anticoagulation and systemic thrombolysis in acute pulmonary embolism and riociguat and pulmonary endarterectomy in CTEPH.


Assuntos
Hipertensão Pulmonar , Embolia Pulmonar , Doença Aguda , Cateteres , Endarterectomia , Humanos , Hipertensão Pulmonar/terapia , Embolia Pulmonar/complicações , Embolia Pulmonar/terapia
17.
Expert Rev Med Devices ; 18(11): 1039-1048, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34530650

RESUMO

INTRODUCTION: Pulmonary embolism (PE) is the third leading cause of cardiovascular mortality. There has been little change in PE mortality rates over the past two decades making this an appealing area for innovation and development. AREAS COVERED: While anticoagulation (AC) and systemic thrombolysis (ST) are the mainstay treatments for high-risk PE and intermediate-high-risk PE with decompensation, advancements in catheter- based therapies offer potential alternatives. Areas covered here will include present guidelines for PE treatment and the landscape of catheter-directed therapies with a focus on the FlowTriever (FT) Retrieval System. Available safety and efficacy data will be reviewed. An online search via Google Scholar and PubMed with the keywords INARI Flowtriever, venous thromboembolism, and pulmonary embolism, alongside bibliographies of published articles, was undertaken as a review of the literature on the FlowTriever system for this device overview. EXPERT OPINION: The five-year outlook on the role of catheter-directed therapies in the management of PE includes continued innovation in catheter-directed therapies and a number of high-quality trials on the horizon.


Assuntos
Embolia Pulmonar , Terapia Trombolítica , Fibrinolíticos , Humanos , Embolia Pulmonar/terapia , Fatores de Risco , Trombectomia , Resultado do Tratamento
18.
Surg Clin North Am ; 101(5): 925-938, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34537152

RESUMO

Perioperative venous thromboembolism (VTE) is a common complication within the surgical patient population. Perioperative mechanical and chemoprophylaxis have been shown to reduce the incidence of both deep venous thrombosis and pulmonary embolism. Prophylactic regimen must be tailored to the patient's individual risk factors as well as the nature of the procedure. In the event of VTE, treatment most commonly includes long-term anticoagulation, whereas more severe cases may require lytic or mechanical interventions.


Assuntos
Embolia Pulmonar/terapia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Tromboembolia Venosa/terapia , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/terapia , Embolia Pulmonar/etiologia , Embolia Pulmonar/prevenção & controle , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle
19.
Herz ; 46(5): 399-405, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34468788

RESUMO

Acute pulmonary embolism (PE) is a life-threatening condition with high mortality rates and potential long-term sequelae. Systemic thrombolysis has been virtually the only therapeutic option available for patients with hemodynamic instability over decades. Recently, interventional therapy of PE has gained increasing interest. Multiple devices were developed; these include devices for local thrombolysis, thrombus fragmentation, thrombus aspiration, and combined approaches. However, the available evidence is limited to mostly small, nonrandomized studies. In these studies, safety and efficacy data from patients with intermediate or high-risk PE are promising. However, due to the lack of adequately powered randomized trials, interventional treatment of intermediate or high-risk PE cannot be recommended as standard-of-care. The decision on whether and how to perform a catheter-based intervention should therefore be left to the discretion of the local team, depending on the patients' clinical status, bleeding risk, local expertise, and available devices. The implementation of local multidisciplinary PE response teams is recommended by international guidelines to provide the best possible treatment.


Assuntos
Embolia Pulmonar , Trombose , Cateteres , Fibrinolíticos/uso terapêutico , Humanos , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/terapia , Terapia Trombolítica , Trombose/tratamento farmacológico , Resultado do Tratamento
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