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Pulmonary endarterectomy, chronic thromboembolic pulmonary hypertension

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https://www.readbyqxmd.com/read/28875371/the-effective-systematic-heparin-pre-treatment-on-thrombus-formation-on-pulmonary-artery-catheter-tips-during-pulmonary-endarterectomy-for-chronic-thromboembolic-pulmonary-hypertension-a-randomized-double-blind-study
#1
Christoph B Wiedenroth, Christoph Liebetrau, Henning Gall, Thomas Risch, Matthias Arlt, Eckhard Mayer, Stefan Guth
Pulmonary artery (PA) catheters are routinely used for hemodynamic management in patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing pulmonary endarterectomy (PEA). Tip-associated thrombi are frequently detected and might increase the peri-operative risk in these patients. The aim of the study was to investigate the effects of low-dose heparinization before the insertion of the PA catheter on thrombus formation and thrombus weight during PEA surgery. From September 2013 to February 2015, 60 CTEPH patients undergoing PEA were included in the study and randomized into two groups of 30 patients each, including a heparin group (heparin bolus (70 IU per kg body weight) administration before PA catheter insertion) and a control group (pretreatment with placebo)...
September 5, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28821335/symptoms-are-more-useful-than-echocardiography-in-patient-selection-for%C3%A2-pulmonary-endarterectomy
#2
Laura Donahoe, Rachel Vanderlaan, John Thenganatt, Karen McRae, Anastasia Bykova, Jakov Moric, John Granton, Marc de Perrot
BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is still largely underdiagnosed in the general population. Although transthoracic echocardiogram (TTE) is recommended to screen for CTEPH, it may not detect patients with chronic thromboembolic disease (CTED) and mild or exercise-induced pulmonary hypertension (PH) who could also benefit from pulmonary endarterectomy (PEA). METHODS: All patients referred to our CTEPH program with persistent mismatched perfusion defects on ventilation-perfusion (VQ) scan between January 2005 and June 2015 were divided into three groups according to TTE and right heart catheterization (RHC) as follows: (1) typical CTEPH group (PH on RHC and TTE), (2) TTE-negative (neg) CTEPH group (PH on RHC, but not TTE), or (3) CTED group (no PH on RHC and TTE)...
August 16, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28795615/international-survey-on-the-perioperative-management-of-pulmonary-endarterectomy-the-perfusion-perspective
#3
Roger D P Stanzel, Johannes Gehron, Matthias Wolff, Natalie Striegl, Peter Roth, Rolf-Hasso Boedeker, Christine Scheibelhut, Johannes Herrmann, Ingeborg Welters, Eckhard Mayer, Matthias Scheffler
INTRODUCTION: Pulmonary endarterectomy (PEA) is the most effective treatment available for chronic thromboembolic pulmonary hypertension (CTEPH). Patient selection, surgical technique and perioperative management have improved patient outcomes, which are traditionally linked to surgical and center experience. However, optimal perfusion care has not been well defined. The goal of the international survey was to better characterize the contemporary perfusion management of PEA and highlight similarities and controversies...
August 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28750932/pulmonary-endarterectomy-in-chronic-thromboembolic-pulmonary-hypertension
#4
Mareike Lankeit, Valentin Krieg, Lukas Hobohm, Sebastian Kölmel, Christoph Liebetrau, Stavros Konstantinides, Christian W Hamm, Eckhard Mayer, Christoph B Wiedenroth, Stefan Guth
BACKGROUND: Management and outcome of patients with operable chronic thromboembolic pulmonary hypertension (CTEPH) who underwent pulmonary endarterectomy (PEA) at a large German referral center were investigated. METHODS: In Germany, 394 PEAs were performed in 2014 and 2015 with an in-hospital mortality rate of 5.8%. Of these, 253 patients (64.2%) were treated at the Kerckhoff Clinic, Bad Nauheim, and 237 (93.7%; median age, 62 years [interquartile range [IQR], 52-72 years]; 46...
July 1, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/28732819/individual-dose-adjustment-of-riociguat-in-patients-with-pulmonary-arterial-hypertension-and-chronic-thromboembolic-pulmonary-hypertension
#5
REVIEW
Nicholas S Hill, Franck F Rahaghi, Namita Sood, Reiner Frey, Hossein-Ardeschir Ghofrani
Riociguat is a soluble guanylate cyclase stimulator that has been approved for the treatment of pulmonary arterial hypertension and inoperable chronic thromboembolic pulmonary hypertension or persistent/recurrent pulmonary hypertension following pulmonary endarterectomy. Riociguat is administered using an 8-week individual dose-adjustment scheme whereby a patient initially receives riociguat 1.0 mg three times daily (tid), and the dose is then increased every 2 weeks in the absence of hypotension, indicated by systolic blood pressure measurements and symptoms, up to a maximum dose of 2...
August 2017: Respiratory Medicine
https://www.readbyqxmd.com/read/28652963/switching-from-sildenafil-to-riociguat-for-the-treatment-of-pah-and-inoperable-cteph-real-life-experiences
#6
Asger Andersen, Kasper Korsholm, Søren Mellemkjær, Jens Erik Nielsen-Kudsk
Riociguat is a novel soluble guanylate cyclase stimulator that is approved for the treatment of patients with pulmonary arterial hypertension (PAH) and patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) or persistent/recurrent CTEPH after pulmonary endarterectomy (PEA). As riociguat is a relatively new drug, experience of its use in clinical practice is limited, especially in patients who would not have met the inclusion criteria for the pivotal Phase III clinical trials, PATENT-1 and CHEST-1...
2017: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/28628189/-a-statement-the-polish-cardiac-society-working-group-on-pulmonary-circulation-on-screening-for-cteph-patients-after-acute-pulmonary-embolism
#7
Michał Ciurzyński, Marcin Kurzyna, Grzegorz Kopeć, Piotr Błaszczak, Łukasz Chrzanowski, Karol Kamiński, Katarzyna Mizia-Stec, Tatiana Mularek-Kubzdela, Ewa Mroczek, Andrzej Biederman, Piotr Pruszczyk, Adam Torbicki
Both pharmacological and invasive treatment of chronic thromboembolic pulmonary hypertension (CTEPH) is now available in Poland and the awareness of the disease among physicians is growing. Thus, the Polish Cardiac Society's Working Group on Pulmonary Circulation in cooperation with independent experts in this field, have launched the statement on algorithm to guide a CTEPH diagnosis in patients with previous acute pulmonary embolism (APE). In Poland, every year this disease affects about 250 patients. CTEPH should be suspected in individuals after APE with dyspnea, despite at least 3 months period of effective anticoagulation, particularly when specified risk factors are present...
2017: Kardiologia Polska
https://www.readbyqxmd.com/read/28612517/two-dimensional-knowledge-based-volumetric-reconstruction-of-the-right-ventricle-documents-short-term-improvement-in-pulmonary-hypertension
#8
Johannes P Schwaiger, Daniel S Knight, Thomas Kaier, Adele Gallimore, Christopher P Denton, Benjamin E Schreiber, Clive Handler, John G Coghlan
BACKGROUND: Data are scarce about short-term right ventricular changes in pulmonary hypertension. Two-dimensional knowledge-based reconstruction of the right ventricle with 2D echocardiography (2DKBR) has been shown to be a valid alternative to Cardiac MRI. PATIENTS AND METHODS: In this longitudinal study 25 pulmonary hypertension patients underwent 2DKBR of the right ventricle, assessment of NT-proBNP levels and functional class at baseline and after a mean follow-up of 6...
June 2017: Echocardiography
https://www.readbyqxmd.com/read/28591785/results-from-more-than-20%C3%A2-years-of-surgical-pulmonary-endarterectomy-for-chronic-thromboembolic-pulmonary-hypertension-in-denmark
#9
Kasper Korsholm, Asger Andersen, Søren Mellemkjær, Dorthe Viemose Nielsen, Kaj Erik Klaaborg, Lars Bo Ilkjær, Jens Erik Nielsen-Kudsk
OBJECTIVES: Chronic thromboembolic pulmonary hypertension is a fatal disease if left untreated, and pulmonary endarterectomy (PEA) is the potentially curable treatment of choice. We aimed to estimate the current in-hospital mortality rate, complication rate and long-term survival for patients with chronic thromboembolic pulmonary hypertension undergoing PEA in Denmark. METHODS: All chronic thromboembolic pulmonary hypertension patients who underwent PEA in the period 1994 till 2016 were consecutively enrolled in our single-centre study...
June 7, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28553870/changing-the-strategy-of-balloon-pulmonary-angioplasty-resulted-in-a-reduced-complication-rate-in-patients-with-chronic-thromboembolic-pulmonary-hypertension-a-single-centre-european-experience
#10
Marcin Kurzyna, Szymon Darocha, Radosław Pietura, Arkadiusz Pietrasik, Justyna Norwa, Rafał Mańczak, Maria Wieteska, Andrzej Biederman, Hiromi Matsubara, Adam Torbicki
BACKGROUND AND AIM: To assess the safety and efficacy of a refined balloon pulmonary angioplasty (BPA) strategy in patients with chronic thromboembolic pulmonary hypertension (CTEPH). METHODS: There were 157 BPA sessions performed in 56 CTEPH patients (47 non-operable, nine after pulmonary endarterectomy; aged 58.6 ± 17.9 years; 28 females) with severely impaired pulmonary haemodynamics (mean pulmonary artery pressure [mPAP]: 51.3 ± 12.2 mm Hg, pulmonary vascular resistance [PVR]: 10...
2017: Kardiologia Polska
https://www.readbyqxmd.com/read/28528258/epidemiology-and-management-of-chronic-thromboembolic-pulmonary-hypertension-experience-from-two-expert-centers
#11
Maria Anna Bazmpani, Alexandra Arvanitaki, Maria Toumpourleka, Georgia Pitsiou, Evaggelia Panagiotidou, Sophia Anastasia Mouratoglou, Georgios Sianos, Stavros Hadjimiltiades, Antonios Pitsis, Eckhard Mayer, Ioannis Stanopoulos, Haralambos Karvounis, George Giannakoulas
BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare, distinct pulmonary vascular disease, and, therefore, there is lack of data regarding its clinical presentation, diagnosis and management at a national basis. Our objective was to describe the demographics and management of CTEPH patients in Northern Greece. METHODS: We conducted a retrospective, observational study with a joint collaboration from two pulmonary hypertension expert centers in Greece and included patients diagnosed with CTEPH...
May 17, 2017: Hellenic Journal of Cardiology: HJC, Hellēnikē Kardiologikē Epitheōrēsē
https://www.readbyqxmd.com/read/28523175/a-chronic-thromboembolic-pulmonary-hypertension-catch-22-situation-inferior-vena-caval-filter-plays-a-pivotal-role-in-an-unlikely-situation
#12
Karthik Seetharam, Elbert E Williams, Elizabeth Oswald, Ramachandra Reddy
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare clinical entity that occurs in a small subset of acute pulmonary embolism (PE) cases and is surgically cured by pulmonary endarterectomy. We report a case of a 44-year-old female with a complex history of CTEPH treated by thromboendarterectomy who presented with a subdural hematoma while on warfarin. The patient eventually recovered by a multidisciplinary approach, use of inferior vena caval filter, and effective anticoagulation management.
April 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28474349/refined-balloon-pulmonary-angioplasty-a-therapeutic-option-in-very-elderly-patients-with-chronic-thromboembolic-pulmonary-hypertension
#13
Marek Roik, Dominik Wretowski, Andrzej Łabyk, Katarzyna Irzyk, Barbara Lichodziejewska, Olga Dzikowska-Diduch, Dorota Piotrowska-Kownacka, Piotr Pruszczyk
INTRODUCTION/OBJECTIVES: Balloon pulmonary angioplasty (BPA) is a developing treatment for inoperable chronic thromboembolic pulmonary hypertension (CTEPH). However, to our knowledge there are no published data on BPA in CTEPH subjects aged 75 or over. The aim of the study was to analyze clinical and hemodynamic outcomes of sequential BPA in very elderly patients disqualified from pulmonary endarterectomy (PEA). PATIENTS AND METHODS: We enrolled 10 patients (4 male, 6 female, median age 81 [75-88]) with confirmed CTEPH, mPAP > 30 mmHg, and WHO class > II, disqualified from PEA...
May 5, 2017: Journal of Interventional Cardiology
https://www.readbyqxmd.com/read/28458514/riociguat-a-soluble-guanylate-cyclase-stimulator-for-the-treatment-of-pulmonary-hypertension
#14
REVIEW
Tian-Yu Lian, Xin Jiang, Zhi-Cheng Jing
Despite advances in treatments and improved survival, patients with pulmonary hypertension still experience poor exercise and functional capacity, which has a significant detrimental impact on their quality of life. The nitric oxide (NO)-soluble guanylate cyclase (sGC)-cyclic guanosine 3',5'-monophosphate (cGMP) pathway has been shown to play an important role in cardiovascular physiology, especially in vasodilation and pulmonary vascular tone. The oral sGC stimulator riociguat has a dual mode of action on the NO-sGC-cGMP pathway: direct stimulation of sGC independent of NO and indirect simulation via sensitization of sGC to endogenous NO...
2017: Drug Design, Development and Therapy
https://www.readbyqxmd.com/read/28420842/the-development-of-marked-collateral-circulation-due-to-inferior-vena-cava-filter-occlusion-in-a-patient-with-chronic-thromboembolic-pulmonary-hypertension-complicated-with-anti-phospholipid-syndrome
#15
Hajime Kasai, Nobuhiro Tanabe, Ken Koshikawa, Yasutaka Hirasawa, Toshihiko Sugiura, Seiichiro Sakao, Koichiro Tatsumi
A 30-year-old Japanese man was diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) with lupus anticoagulants (LAs) in 2003. He underwent pulmonary endarterectomy after the placement of an inferior vena cava filter (IVCF) in 2004, and treatment with warfarin was continued. In 2014, IVCF occlusion and marked collateral circulation were noted during an examination for transient dyspnea; however, his warfarin level was within the therapeutic range for 88.9% of the time from 2003 to 2014. We herein report a rare case of CTEPH and LAs with IVCF occlusion; in such cases, intense treatment may be required...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28356406/balloon-pulmonary-angioplasty-in-chronic-thromboembolic-pulmonary-hypertension
#16
REVIEW
Irene Lang, Bernhard C Meyer, Takeshi Ogo, Hiromi Matsubara, Marcin Kurzyna, Hossein-Ardeschir Ghofrani, Eckhard Mayer, Philippe Brenot
Chronic thromboembolic pulmonary hypertension (CTEPH) is thought to result from incomplete resolution of pulmonary thromboemboli that undergo organisation into fibrous tissue within pulmonary arterial branches, filling pulmonary arterial lumina with collagenous obstructions. The treatment of choice is pulmonary endarterectomy (PEA) in CTEPH centres, which has low post-operative mortality and good long-term survival. For patients ineligible for PEA or who have recurrent or persistent pulmonary hypertension after surgery, medical treatment with riociguat is beneficial...
March 31, 2017: European Respiratory Review: An Official Journal of the European Respiratory Society
https://www.readbyqxmd.com/read/28356404/medical-management-of-chronic-thromboembolic-pulmonary-hypertension
#17
REVIEW
Joanna Pepke-Zaba, Hossein-Ardeschir Ghofrani, Marius M Hoeper
Chronic thromboembolic pulmonary hypertension (CTEPH) results from incomplete resolution of acute pulmonary emboli, organised into fibrotic material that obstructs large pulmonary arteries, and distal small-vessel arteriopathy. Pulmonary endarterectomy (PEA) is the treatment of choice for eligible patients with CTEPH; in expert centres, PEA has low in-hospital mortality rates and excellent long-term survival. Supportive medical therapy consists of lifelong anticoagulation plus diuretics and oxygen, as needed...
March 31, 2017: European Respiratory Review: An Official Journal of the European Respiratory Society
https://www.readbyqxmd.com/read/28331450/pulmonary-thromboendarterectomy-for-pulmonary-hypertension-before-considering-transplant
#18
Hannah Kooperkamp, Inder Mehta, David Fary, Michael Bates
BACKGROUND: In cases of chronic thromboembolic pulmonary hypertension (CTEPH), referral for possible surgical intervention is important because surgery can be curative. Surgery necessitates cardiopulmonary bypass and deep circulatory arrest with pulmonary thrombectomy and bilateral endarterectomy (PTE). If surgery fails, lung transplant is the next best surgical option. Medical treatment is also an important adjunct. CASE REPORT: A 35-year-old female presented 3 months after a pulmonary embolus was found to be completely occluding her left pulmonary artery...
2017: Ochsner Journal
https://www.readbyqxmd.com/read/28316030/a-new-ct-score-as-index-of-hemodynamic-changes-in-patients-with-chronic-thromboembolic-pulmonary-hypertension
#19
Maria Barbara Leone, Marica Giannotta, Massimiliano Palazzini, Mariano Cefarelli, Sofia Martìn Suàrez, Enrico Gotti, Maria Letizia Bacchi Reggiani, Maurizio Zompatori, Nazzareno Galiè
PURPOSE: The aim of this study was to retrospectively assess the relationship between radiological and hemodynamic parameters in patients with chronic thromboembolic pulmonary hypertension (CTEPH). We introduced a new CT-score to evaluate hemodynamic changes, only employing CT-pulmonary angiography (CTPA). MATERIALS AND METHODS: 145 patients affected by CTEPH underwent hemodynamic and CTPA evaluation. Among these 145 patients, 69 underwent pulmonary endarterectomy (PEA) and performed a CTPA evaluation even after surgery...
July 2017: La Radiologia Medica
https://www.readbyqxmd.com/read/28298388/pulmonary-endarterectomy-in-the-management-of-chronic-thromboembolic-pulmonary-hypertension
#20
REVIEW
David Jenkins, Michael Madani, Elie Fadel, Andrea Maria D'Armini, Eckhard Mayer
Chronic thromboembolic pulmonary hypertension (CTEPH) is a type of pulmonary hypertension, resulting from fibrotic transformation of pulmonary artery clots causing chronic obstruction in macroscopic pulmonary arteries and associated vascular remodelling in the microvasculature.Pulmonary endarterectomy (PEA) offers the best chance of symptomatic and prognostic improvement in eligible patients; in expert centres, it has excellent results. Current in-hospital mortality rates are <5% and survival is >90% at 1 year and >70% at 10 years...
January 2017: European Respiratory Review: An Official Journal of the European Respiratory Society
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