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Submassive pulmonary embolism

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https://www.readbyqxmd.com/read/29219944/minimally-invasive-surgical-pulmonary-embolectomy-a-potential-alternative-to-conventional-sternotomy
#1
Chetan Pasrija, Aakash Shah, Elliot Sultanik, Michael Rouse, Mehrdad Ghoreishi, Gregory J Bittle, Francesca Boulos, Bartley P Griffith, Zachary N Kon
OBJECTIVE: Surgical pulmonary embolectomy has gained increasing popularity over the past decade with multiple series reporting excellent outcomes in the treatment of submassive pulmonary embolism. However, a significant barrier to the broader adoption of surgical pulmonary embolectomy remains the large incision and long recovery after a full sternotomy. We report the safety and efficacy of using a minimally invasive approach to surgical pulmonary embolectomy. METHODS: All consecutive patients undergoing surgical pulmonary embolectomy for a submassive pulmonary embolism (2015-2017) were reviewed...
December 6, 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/29206697/perioperative-pulmonary-thromboembolism-current-concepts-and-treatment-options
#2
David M Ruohoniemi, Akhilesh K Sista, Charles F Doany, Paul M Heerdt
PURPOSE OF REVIEW: Anesthesiologists are familiar with pulmonary emboli prophylaxis paradigms and many have witnessed acute intraoperative embolization. Clinicians must balance conservative anticoagulation and aggressive intervention in perioperative submassive pulmonary emboli, yet the bulk of the literature excludes surgery as a relative contraindication. This review will summarize the current treatment options for acute pulmonary emboli, drawing attention to special considerations in perioperative submassive pulmonary emboli, and discuss right ventricular monitoring to improve assessment of intervention efficacy...
December 4, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29191822/systemic-thrombolysis-in-a-patient-with-massive-pulmonary-embolism-and-recent-glioblastoma-multiforme-resection
#3
Joshua Lampert, Behnood Bikdeli, Philip Green, Matthew R Baldwin
While trials of systemic thrombolysis for submassive and massive pulmonary embolism (PE) report intracranial haemorrhage (ICH) rates of 2%-3%, the risk of ICH in patients with recent brain surgery or intracranial neoplasm is unknown since these patients were excluded from these trials. We report a case of massive PE treated with systemic thrombolysis in a patient with recent neurosurgery for an intracranial neoplasm. We discuss the risks and benefits of systemic thrombolysis for massive PE in the context of previous case reports, prior cohort studies and trials, and current guidelines...
November 29, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29178134/vector-velocity-imaging-echocardiography-to-study-the-effects-of-submassive-pulmonary-embolism-on-the-right-atrium
#4
Umar A Khan, Gerard P Aurigemma, Dennis A Tighe
OBJECTIVES: To assess the effects of submassive pulmonary embolism (SMPE) on right atrial (RA) anatomy and function. BACKGROUND: Right ventricular dysfunction (RVD) is associated with adverse outcomes in SMPE. However, the effects of SMPE on the structure and function of the RA have received much less attention. METHODS: Fifty patients with SMPE documented by CT angiography (SMPE group) and evidence of RVD on two-dimensional echocardiography were retrospectively identified and compared to 50 controls (control group)...
November 27, 2017: Echocardiography
https://www.readbyqxmd.com/read/29167216/a-rare-case-of-dual-diagnosis-in-a-16-year-old-girl-with-shortness-of-breath
#5
Felicity de Vere, Robyn House, Yunus Gokdogan
Pneumothorax and pulmonary embolism (PE) are two life-threatening causes of shortness of breath in patients presenting to the emergency department. A rare but more serious presentation is that of simultaneous PE and pneumothorax. We present the case of a young patient, with no known comorbidities, who presented with simultaneous submassive PE and pneumothorax. We will review how these two diagnoses may be related, consider the implications of having this dual diagnosis on the patient's management and review the current evidence surrounding thrombolysis in submassive PE...
November 21, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29151532/association-of-admission-glucose-level-and-improvement-in-pulmonary-artery-pressure-in-patients-with-submassive-type-acute-pulmonary-embolism
#6
Masaomi Gohbara, Keigo Hayakawa, Azusa Hayakawa, Yusuke Akazawa, Yukihiro Yamaguchi, Shuta Furihata, Ai Kondo, Yusuke Fukushima, Sakie Tomari, Takayuki Mitsuhashi, Tsutomu Endo, Kazuo Kimura
Objective The admission glucose level is a predictor of mortality even in patients with acute pulmonary embolism (APE). However, whether or not the admission glucose level is associated with the severity of APE itself or the underlying disease of APE is unclear. Methods This study was a retrospective observational study. A pulmonary artery (PA) catheter was used to accurately evaluate the severity of APE. The percentage changes in the mean PA pressure (PAPm) upon placement and removal of the inferior vena cava filter (IVCF) were evaluated...
November 20, 2017: Internal Medicine
https://www.readbyqxmd.com/read/29146419/syncope-on-presentation-is-a-surrogate-for-submassive-and-massive-acute-pulmonary-embolism
#7
Hesham R Omar, Mehdi Mirsaeidi, Michael B Weinstock, Garett Enten, Devanand Mangar, Enrico M Camporesi
INTRODUCTION: There are conflicting data regarding the prognostic value of syncope in patients with acute pulmonary embolism (APE). METHODS: We retrospectively reviewed data of 552 consecutive adults with computed tomography pulmonary angiogram-confirmed APE to determine the correlates and outcome of the occurrence of syncope at the time of presentation. RESULTS: Among 552 subjects with APE (mean age 54years, 47% men), syncope occurred in 12...
November 7, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29102272/aspiration-thrombectomy-for-treatment-of-acute-massive-and-submassive-pulmonary-embolism-initial-single-center-prospective-experience
#8
Juan José Ciampi-Dopazo, Juan María Romeu-Prieto, Marcelino Sánchez-Casado, Beatriz Romerosa, Alfonso Canabal, María Luisa Rodríguez-Blanco, Carlos Lanciego
PURPOSE: To evaluate the feasibility of aspiration thrombectomy in patients with acute massive or submassive pulmonary embolism (PE). MATERIALS AND METHODS: This prospective study analyzed patient demographic data, procedural details, and outcomes in 18 consecutive patients (8 men and 10 women; mean age, 60.1 y; range, 36-80 y), 10 with acute submassive PE and 8 with massive PE, treated with an Indigo Continuous Aspiration Mechanical Thrombectomy Catheter between January 2016 and February 2017...
October 25, 2017: Journal of Vascular and Interventional Radiology: JVIR
https://www.readbyqxmd.com/read/29074107/risk-factors-for-presence-and-severity-of-pulmonary-embolism-in-patients-with-deep-venous-thrombosis
#9
Nancy Huynh, Wassim H Fares, Kirstyn Brownson, Anand Brahmandam, Alfred I Lee, Alan Dardik, Timur Sarac, Cassius Iyad Ochoa Chaar
OBJECTIVE: The Caprini model estimates patients' risk for venous thromboembolism by 30 different factors. Hemodynamically significant pulmonary embolism (PE), defined as high-risk (massive) or intermediate-risk (submassive) PE, has high morbidity and mortality rates. This study tests whether the Caprini model and deep venous thrombosis (DVT) characteristics correlate with the prevalence of PE and hemodynamically significant PE in patients with DVT. METHODS: A retrospective review of patients diagnosed with DVT between January 2013 and August 2014 in a tertiary care center was performed...
October 23, 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/29068112/use-of-systemic-bivalirudin-with-catheter-directed-thrombolysis-in-a-patient-with-heparin-induced-thrombocytopenia-a-case-report
#10
Hisham A Badreldin, Jessica Rimsans, Jean M Connors, Stephen D Wiviott
In patients with submassive pulmonary embolism, the use of catheter-directed thrombolysis (CDT), using low-dose alteplase is associated with improvement in overall hemodynamics. The data for use of CDT in patients with heparin-induced thrombocytopenia are limited. We report a case of CDT in a patient with HIT using bivalirudin anticoagulation. Data of the use of bivalirudin and argatroban for systemic anticoagulation with CDT are limited.
October 25, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/29030065/diuretics-versus-volume-expansion-in-acute-submassive-pulmonary-embolism
#11
Elie Dan Schouver, Olivier Chiche, Priscille Bouvier, Denis Doyen, Pierre Cerboni, Pamela Moceri, Emile Ferrari
BACKGROUND: The benefit of volume expansion (VE) in submassive pulmonary embolism (PE) with right ventricular (RV) dysfunction is unclear. AIM: To compare the effects of diuretic treatment versus VE in patients hospitalized for PE with RV dysfunction. METHODS: We prospectively included 46 consecutive patients with submassive PE treated on admission with a 40mg bolus of furosemide (D group, n=24) or 500mL of saline infusion (VE group, n=22)...
November 2017: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/29029714/catheter-directed-therapy-for-acute-submassive-pulmonary-embolism-summary-of-current-evidence-and-protocols
#12
REVIEW
Andrew Kesselman, William T Kuo
Treatment of acute submassive pulmonary embolism (PE) with thrombolytic therapy remains an area of controversy. For patients who fail or who have contraindications to systemic thrombolysis, catheter-directed therapy (CDT) may be offered depending on the patient's condition and the available institutional resources to perform CDT. Although various CDT techniques and protocols exist, the most studied method is low-dose catheter-directed thrombolytic infusion without mechanical thrombectomy. This article reviews current protocols and data on the use of CDT for acute submassive pulmonary embolism...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029713/techniques-and-devices-for-catheter-directed-therapy-in-pulmonary-embolism
#13
REVIEW
Alok Bhatt, Ramsey Al-Hakim, James F Benenati
The clinical presentation of a patient with acute pulmonary embolism (PE) can be classified into 3 categories: low-risk, submassive (presence of right heart strain), and massive (hemodynamic compromise). Massive PE is associated with high morbidity or mortality and typically treated with systemic intravenous thrombolysis. Over the last 2 decades, however, catheter-directed techniques have become an increasingly popular treatment modality for patients with a contraindication to systemic thrombolysis or without clinical improvement after systemic thrombolysis...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029711/surgical-embolectomy-for-massive-and-submassive-pulmonary-embolism-and-pulmonary-thromboendarterectomy-for-chronic-thromboembolic-pulmonary-hypertension
#14
REVIEW
Richard J Shemin
Surgical therapy for massive acute pulmonary embolism has improved with the use of rapid response teams and selective bedside extracorporeal membrane oxygenation initiation. The chronic consequence of unresolved pulmonary embolism is a treatable form of pulmonary hypertension. Pulmonary thromboendarterectomy is a curative operation in selected cases, operated upon in an experienced center with the multidisciplinary team including imaging, pulmonary medicine, and cardiothoracic surgery.
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029710/systemic-thrombolysis-for-pulmonary-embolism-who-and-how
#15
REVIEW
Victor F Tapson, Oren Friedman
Anticoagulation has been shown to improve mortality in acute pulmonary embolism (PE). Initiation of anticoagulation should be considered when PE is strongly suspected and the bleeding risk is perceived to be low, even if acute PE has not yet been proven. Low-risk patients with acute PE are simply continued on anticoagulation. Severely ill patients with high-risk (massive) PE require aggressive therapy, and if the bleeding risk is acceptable, systemic thrombolysis should be considered. However, despite clear evidence that parenteral thrombolytic therapy leads to more rapid clot resolution than anticoagulation alone, the risk of major bleeding including intracranial bleeding is significantly higher when systemic thrombolytic therapy is administered...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029706/pulmonary-embolism-in-2017-how-we-got-here-and-where-are-we-going
#16
REVIEW
Geno J Merli
In the 1970s, both the Urokinase Pulmonary Embolism and Urokinase-Streptokinase Pulmonary Embolism trials began the quest to develop thrombolytic therapy for the treatment of acute massive and submassive pulmonary embolism (PE). The goals of these studies were the immediate reduction in clot burden, restoration of hemodynamic stability, and improved survival. Major bleeding became the major barrier for clinicians to employ these therapies. From 1980s to the present time, a number of studies using recombinant tissue-type plasminogen activator for achieving these same above outcomes were completed but major bleeding continued to remain an adoption barrier...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/28993433/management-of-thromboembolism-in-transit-with-pulmonary-embolism
#17
V S Ellensen, S Saeed, T Geisner, R Haaverstad
We present a rare complication of deep venous thrombosis with pulmonary embolism that threatened the patient with systemic embolization. A 36-year-old female was referred to the hospital after five days of progressive shortness of breath and chest pain. Preceding onset of symptoms she had undergone surgery leading to reduced physical activity and had just returned from vacation by a long flight. Investigations with transthoracic and transesophageal echocardiography revealed a thromboembolism-in-transit across a patent foramen ovale...
October 9, 2017: Echo Research and Practice
https://www.readbyqxmd.com/read/28958757/clinical-characteristics-risk-factors-and-outcomes-of-south-east-asian-patients-with-acute-pulmonary-embolism
#18
Kwang How Mok, Shiun Woei Wong, Yee May Wong, David Foo, Timothy James Watson, Hee Hwa Ho
BACKGROUND: The clinical features of acute PE have not been well studied in South-East Asia. We therefore sought to evaluate the clinical characteristics, risk factors and outcomes of patients diagnosed with acute pulmonary embolism (PE) in our region. METHODS: From January 2008 to March 2013, 343 patients were admitted to our tertiary institution with acute PE. Data were collected retrospectively on baseline clinical characteristics, presenting signs and symptoms, results of electrocardiographic and imaging studies, therapeutic modality and hospital course...
December 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28957940/comparison-of-acute-and-convalescent-biomarkers-of-inflammation-in-patients-with-acute-pulmonary-embolism-treated-with-systemic-fibrinolysis-vs-placebo
#19
Lauren K Stewart, Kristen E Nordenholz, Mark Courtney, Christopher Kabrhel, Alan E Jones, Matthew T Rondina, Deborah B Diercks, James R Klinger, Jeffrey A Kline
: Previous studies have associated biomarkers indicative of acute inflammation with pulmonary embolism, which may amplify coagulation, inhibit fibrinolysis and increase risk of venous thromboembolism (VTE) recurrence. The aim of this study was to measure inflammatory and hemostatic biomarkers in acute submassive pulmonary embolism at diagnosis and 3-month follow-up and to test the impact of treatment with fibrinolysis. Secondary analysis of a multicenter, double-blinded, randomized controlled trial including patients with submassive pulmonary embolism...
September 27, 2017: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
https://www.readbyqxmd.com/read/28956501/express-catheter-directed-therapy-for-submassive-pulmonary-embolism-after-unsuccessful-systematic-thrombolysis
#20
Chang Dong, Shunfen Jiang, Donghua Ji, Yingqun Ji, Zhonghe Zhang
No abstract text is available yet for this article.
January 1, 2017: Pulmonary Circulation
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