Pulmonary Artery Thromboembolism Research Articles

Combined ostium secundum type ASD and pulmonary arterial thromboembolism causing pulmonary artery enlargement, pulmonary hypertension and recurrent paradoxical cerebral embolism due to deep venous thrombosis

Combined ostium secundum type ASD and pulmonary arterial thromboembolism causing pulmonary artery enlargement, pulmonary hypertension and recurrent paradoxical cerebral embolism due to deep venous thrombosis

Pulmonary thromboembolism and errors of its lifetime diagnostics

The objective of the present study was the forensic medical evaluation of the importance of clinical and morphological manifestations of the venous thromboembolic complications (VTEC) for the early diagnostics of pulmonary thromboembolism. The article presents a detailed information about the VTEC morbidity rate and mortality from pulmonary artery thromboembolism (PATE) with special reference to the possible clinical variants and outcomes of this pathology. The importance of studying VTEC morbidity is substantiated. An episode from the personal expert practical work is reported to illustrate errors of lifetime diagnostics of pulmonary artery thromboembolism. Special attention is given to the necessity of the comprehensive examination of the patients presenting with VTEC for the lifetime diagnostics of pulmonary artery thromboembolism. The great value of the comprehensive pathological anatomic (forensic medical) investigation for postmortem diagnostics of VTEC is emphasized. It is concluded that the integrated approach is needed to the conduction of forensic medical expertise of the subjects presenting with the manifestations of the venous thromboembolic complications.

Effects of Proximal Pulmonary Artery Occlusion on Pulsatile Right Ventricular Afterload in Rats.

In patients with proximal pulmonary artery (PA) thromboembolism, an increased PA resistance contributes to abnormal right ventricular (RV) afterload. However, the effects of proximal thromboembolism on the dynamic properties of RV afterload, which is determined by PA impedance, have not been analyzed quantitatively. The present study aimed to identify changes in PA impedance after the pulmonary perfusion volume was greatly reduced by unilateral proximal PA occlusion. Ten male Sprague-Dawley rats were used. PA flow and pressure waveforms were recorded during irregular pacing, before and 10 min after left PA occlusion. PA impedance was parameterized by using a three-element Windkessel model consisting of peripheral resistance (RP), arterial compliance (CP) and characteristic impedance (ZC). After proximal PA occlusion, PA impedance modulus increased over a frequency range of interest.ZCincreased significantly (after PA occlusion vs. baseline: 0.128±0.016 vs. 0.074±0.010 mmHg·min/ml, P<0.001), whereasCPandRPdid not change significantly. Proximal PA occlusion increasedZCwith the attenuation ofRPincrease andCPdecrease predicted from the decreased pulmonary perfusion volume. The insignificant changes inRPandCPindicate that a recruitment phenomenon may result in this attenuation. The existence of compensation by a recruitment mechanism suggests the relative importance of increasedZCin defining abnormal RV afterload in patients with proximal PA thromboembolism. (Circ J 2016; 80: 2010-2018).

Massive Pulmonary and Coronary Artery Thromboembolism in the Setting of Undetected Patent Foramen Ovale

Invasive surgery brings with it a unique set of post-surgical risks that are directly dependent on various factors including the specific surgical approach used, pre-existing comorbidities and features such as gender and age. Pulmonary thromboembolism is one of the most feared complications following surgery, and diagnosis and treatment of this entity is a challenging task for the clinician. Here we describe a case of massive pulmonary thromboembolism and associated coronary artery thromboemboli status post spinal fusion surgery in a 68 year-old man with an undetected patent foramen ovale (PFO). Although the decedent was managed clinically with proper deep venous thrombosis prophylaxis protocols and physical rehabilitation, he went into cardiorespiratory arrest after experiencing acute oxygen desaturation and newly detected right bundle branch block. PFO can be incidentally found in 25% of the adult population. Several clinical syndromes including stroke, migraine headaches and obstructive sleep apnea have been associated in patients with PFO, the last two from which the decedent suffered. The pathology of this unique case of massive pulmonary thromboembolism resulting in coronary artery thromboemboli in the setting of an undetected PFO is discussed. The discovery of PFO in patients prior to surgery, if detected early, may improve post-surgical outcomes. [Display omitted] [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Тромбоэмболия легочной артерии у раненого с сочетанной минно-взрывной травмой на фоне проведения антикоагулянтной профилактики (клинический случай)

Venous thrombosis and pulmonary embolism in healthy military are rare. Fighting surgical trauma is the trigger of a cascade of defense reactions of the body and the blood coagulation system, leading to stop bleeding. Hemostatic disorders, shifting the equilibrium toward hypercoagulable state, the emergence of the risk factors associated with the injury, lead to uncontrolled thrombosis with subsequent development of venous thromboembolic complications. We present the case of the left pulmonary artery thromboembolism in 41 year old wounded with a gunshot fracture of the right femur, obtained by blowing an unknown explosive device. Medical assistance was provided in three stages of evacuation. In order to stabilize a femur fracture the external fixation device was used. According coagulogram thrombinemia persisted for more than 30 days. Prevention of thrombosis carried LMWH (Clexane), with 9 days after injury. 31 day angiography was performed computer, identified thrombus by 70% ceiling clearance left pulmonary artery; by ultrasound scanning of the veins of the lower limbs was diagnosed asymptomatic thrombosis of the right iliofemoral. Against the background of complex treatment for 67 hours after the injury occurred recanalization. This case shows that the injured limb wound clinical symptoms of the disease symptoms negate venous thrombosis, which becomes the only manifestation of pulmonary embolism. Prevention of venous thromboembolic events, as well as monitoring of its effectiveness, should be carried out at all stages of the evacuation of the wounded and for the entire period of the presence of risk factors for their development.

FOURNIER’S GANGRENE- VARIETY OF CLINICAL MODEL OF CRITICAL STATES IN SURGERY

The investigation based on a retrospective analysis of the treatment results of Fournier's gangrene (FG) in 27 patients aged from 34 till 82 years old. There were 27 patients. Diseases of colorectal zone were the nosological reasons of FG in 15 patients. Diseases of urogenital tract had 10 patients with FG. The development of FG was determined by closed trauma (1 patient) and a gunshot wound of the perineum and the scrotum in one patient. The slowly progressive (limited) forms of the disease were noted in 15 patients, although the rapid progressive (extensive) forms were in 12 patients.All the patients had the clinical manifestations of the disease and at the same time laboratory indices indicated a presence of generalized infection and they were characterized by symptoms of systemic inflammatory response syndrome (SIRS). There were 6 patient, who died out of 27.The lethality consisted of 22.2%. The reasons of the death were an infection-toxic shock (1 case), a progressive endotoxicosis (3 cases) and a pulmonary artery thromboembolism (2 cases). The results obtained testified that early diagnostics and the active strategy with radical surgical d-bridement of necrotic suppurative foci combined with programmed (staged) sanitation necrosectomy, complex system of local wound treatment, the rational antibacterial therapy, a task-specific and syndrome correction of dyscrasia could be the actual ways to improve the treatment results in patients with FG.

Use of Technetium-99m-Labelled Sodium Diphosphate Decahydrate to Assess Right Ventricle Dysfunction in Patients with Pulmonary Embolism

The objective of this study was to identify the signs of the right ventricular dysfunction in patients with non-massive pulmonary artery thromboembolism (PE) using radionuclide gated blood pool SPECT (GBPS). The study included 55 patients: 40 with PE, and 15 - control group. Radionuclide studies included perfusion-ventilation scintigraphy and GBPS. GBPS results suggest that the signs of right ventricular dysfunction in PE are: the reduction in its stroke volume, as well as reduction in the peak filling and ejection rate. GBPS results allow distinguishing acute thromboembolism and chronic post-thromboembolic pulmonary hypertension.

Mortality after Gastrectomy: a 10 Year Single Institution Experience

Background : Although the general postoperative mortality rate after gastrectomy is decreasing worldwide, it still varies in individual centers and regions of the world. The objective of our work was to analyze the postoperative mortality rate at the Institute of Oncology, Vilnius University over a period of 10 years.Methods : All patients who underwent total and subtotal gastrectomy for gastric cancer between 2003–2012 were retrospectively analyzed. Comprehensive evaluation of postoperative mortality was done according to the age, sex, comor-bidities, BMI, tumor stage, extent or resection and lymphadenectomy, splenectomy, neoadjuvant chemotherapy and stage of disease. The causes of death were also analyzed.Results : The analysis of postoperative mortality for patients treated for gastric cancer in the period of 2003–2012 revealed that 1676 surgeries were performed with 54 lethal outcomes (3.22%). Complication rate was 20.58%. 1011 subtotal gastrectomies were performed with 24 lethal cases (2.37%). 30 patients died after 665 total gastrectomies (4.51%). The vast majority of deceased patients were older than 60 years (92.6%) and had advanced gastric cancer - stage III and IV (70.4%). 33 of 54 patients died from non-surgical complications (61.1%). Surgical complications accounted for 35.2% of dead patients, which totals 19 of 54 patients. Progression of cancer and cachexia caused the deaths of 3.7% of patients.Conclusion : Elderly age, comorbidities, advanced stage of tumor and disease, and more radical surgery are related with higher postoperative mortality. The most common cause of death was pulmonary arterial thromboembolism. Therefore, risk assessment of venous thrombosis and thromboembolism prophylaxis should be an important component of gastric cancer surgical treatment.

Abstract 15578: The Combination of an Ostium Secundlum Type Atrial Septal Defect with a Pulmonary Arterial Thromboembolism Caused an Enlarged Pulmonary Artery, Pulmonary Hypertension and Recurrent Paradoxical Cerebral Embolism due to Deep Vein Thrombosis

A 65 year old female was referred to our hospital with dyspnea on effort. When she was 42 years old, she was diagnosed by transthoracic echocardiology (TTE) with an ostium secundlum type atrial septal defect (ASD) with a pre-existing right to left shunt through the ASD. When she was 60 years old, she was diagnosed with a brain abscess due to a paradoxical cerebral embolism and admitted to our brain surgery ward a total of three times. The diagnosis was confirmed and treatment with Clopidogrel sulfate was started. Six months ago, she felt dyspnea on effort and gradually worsened. She was referred to our department for further examination. Chest X ray revealed cardiac enlargement with a cardiothoracic ratio of 61%. Serum d dimer and brain natriuretic peptide were elevated to 3.3μg/ml and 492pg/mL, respectively. TTE showed an enlarged PA, right atria (RA) and right ventricle (RV) with a thickened RV wall. A bidirectional shunt through a large ASD could also be observed. PA systolic pressure was estimated, by the pressure gradient from tricuspid valve regurgitation, at 94mmHg. CT revealed an enlarged, calcified PA with a mural thrombus, enlarged and thickened RV wall and a right to left shunt through the ASD. The LV was compressed by the RV, suggesting RV pressure load. Because a mural thrombus was observed in the PA, CT acquisitions of the lower extremities were added 3 minutes after contrast injection. An enlarged popliteal vein with a deep venous thrombus (DVT) was observed. Tadalafil was prescribed for pulmonary hypertension to improve oxygen concentration. Heparin followed by warfarin was administered for the DVT and mural thrombus in the PA. At follow up, CT showed no change to the mural thrombus in the PA, therefore home oxygen therapy was started. From experience of this case, and in subjects with Eisenmenger ASD, if severe PA dilation and PA hypertension and paradoxical cerebral embolism are detected, one should also suspect PA thromboembolism due to DVT.

C0031: Pulmonary Artery Thromboembolism in Oncologic Children

C0031: Pulmonary Artery Thromboembolism in Oncologic Children

Mortality in patients in providing emergency medical care at a pre‐hospital stage (652.18)

Introduction. Providing of emergency medical care to the patients in the pre‐hospital phase has a great importance in medicine.Material. The analysis was made of the calls of Astana city ambulance teams to patients who have been pronounced dead in the presence of doctors from 2006 to 2012. In total, 1002 cases were registered.Results. By nosology the patients were distributed as follows: acute coronary pathology (69.7%), strokes (12.7%), pulmonary arterial thromboembolism (6.0%), asthma status (2.8%), infectious‐toxic shock (2.2%) and other diseases (6.6%). In 137 cases, the pain was assessed as “very severe”, in 88 ‐ as “severe”. Acute cardiovascular insufficiency of 2nd and 3rd degree according to Killip was observed in 132 patients.115 patients had baseline sinus tachycardia, other arrhythmias were in 19 patients.60 patients were observed with a violation of A‐V conduction (1st degree A‐V block ‐ 39 cases, 2nd degree A‐V block of Mobits II type ‐ 4 cases and 3rd degree A‐V block ‐ 17 cases). Myocardial infarction was localized in anterior wall in 141 patient and in 87 patients ‐ in the rear wall. Right ventricular myocardial infarction was in 3 patients. Pathologic Q wave on the electrocardiograms was formed in 139 patients.The rise of ST interval above contour line for more than 5 mm was observed in 186 patients.16 patients were detected with the prolongation of QT interval above normal, calculated by Bazett formula.

Elevated Hyaluronan Levels in Patients with Rheumatic Mitral Stenosis and Pulmonary Arterial Thromboembolism

The role of hyaluronan (HA) was previously demonstrated in patients with idiopathic pulmonary arterial hypertension (PAH). Mitral stenosis (MS) and pulmonary arterial thromboembolism (PTE) are important health problems that can cause pulmonovascular pathology. Pulmonary arterial hypertension develops especially in untreated patients with severe MS and most of patients with PTE. However, there is no data about HA levels in patients with MS and PTE. In this study, we investigated HA levels in patients with rheumatic MS and PTE. Study population was divided into three groups. MS group consisted of 18 patients with moderate or severe MS. PTE group consisted of 16 patients with PTE. Control group consisted of 15 subjects without cardiac and pulmonary disease. Percutaneous mitral balloon valvuloplasty (PMV) was performed on all patients in MS group. Mitral gradients and systolic pulmonary arterial pressure (sPAP) were measured in all patients. HA levels were measured at baseline and first month after PMV. Mean sPAP±SD (mmHg) was 23±3 in the control group, 44±9 in the MS group and 66±11 in the PTE group (p<0.001). Baseline serum HA levels were significantly correlated with sPAP(echo) (r=0.332 p=0.03) and sPAP(cath) (r=0.559, p=0.007). Serum HA levels (ng/ml) in MS were significantly higher compared to controls [39±14 vs 24±11; p=0.01]. Patients in PTE group had the highest HA levels (61±21; p<0.001). Serum HA levels were significantly decreased at the first month after PMV in patients with MS [MS group: 39±14 (ng/ml), after PMV: 31±8; p=0.03]. This is the first article showing that both MS and PTE can cause increased serum HA levels. HA levels were decreased with PMV procedure in patients with MS.

Differentiation of pulmonary artery sarcoma from pulmonary embolus utilizing 128-slice dual source prospective cardiac-gated computed tomography scan

Primary pulmonary artery sarcoma is a rare malignancy with poor prognosis that frequently presents with symptoms of PA obstruction, pulmonary arterial hypertension, and right ventricular failure. More frequently seen extensive thromboembolic disease presents similarly, which can delay definitive imaging diagnosis and management. Magnetic resonance imaging (MRI) is highly specific for identifying PA sarcomas because the tumor enhances with gadolinium contrast more than bland thrombus. Chest computed tomography (CT) scan findings such as a low-attenuation filling defect occupying the entire luminal diameter of the main or proximal PA, an expansion of any segment of the pulmonary artery with an extensive intraluminal filling defect, or extraluminal extension can also help differentiate pulmonary artery sarcomas from pulmonary artery thromboembolism. As much as delayed phase contrast enhancement has helped in differentiating between benign and malignant mass lesions, visualization of a low attenuation filling defect within a pulmonary artery on contrast-enhanced cardiac CT studies can further suggest malignancy, such as pulmonary artery sarcoma, if the lesion demonstrates enhancement throughout the delayed phase.

Perfusion scintigraphy method for the diagnosis of pulmonary circulation disorders in rats during disease simulation.

We proposed a modified method for radiological studies of the lungs in small laboratory animals applicable for studies of vascular dysfunctions at different stages of experimental disease formation - chronic obstructive disease of the lungs and pulmonary artery thromboembolism.

A Case of Pulmonary Hypertension Recurred by Graves’ Disease

&lt;p&gt;A few cases of severe pulmonary hypertension with right heart failure associated with Graves’ disease were reported in the literature. However, cases of pulmonary hypertension with right heart failure recurred by Graves’ disease is very rare. We describe the case of a 60-year old woman who had been treated pulmonary hypertension caused by right pulmonary artery thromboembolism seven years ago. Recently, her pulmonary hypertension with right heart failure was recurred by Graves’ disease. The patient’s symptoms of pulmonary hypertension was resolved after treatment of Graves’ disease.&lt;/p&gt;

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Introduction: A 36 year old male underwent AVR with aortic root and sinus of valsalva enlargement. Patient recovered and was transferred out of ICU on POD (postoperative day) 3. On POD 4 he was reintubated for respiratory insufficiency and heparin was started for femoral deep vein thrombosis. On POD 10 argatroban was started for suspected HIT (high 4Ts score); diagnosis later confirmed with a positive heparin platelet factor 4 antibody and serotonin release assay. Emergent embolectomy was performed for large right and left main pulmonary artery thromboemboli which were causing recurrent pulseless electrical activity requiring near continuous cardiopulmonary resuscitation. Intraoperatively a clot was found adherent to the right atrial wall and right atrial appendage; the appendage was extracted and remaining clot debulked. ECMO was required for oxygenation and right ventricular failure. Consumptive coagulopathy and DIC developed. The patient was placed in a hypothermic protocol for CNS resuscitation. Argatroban anticoagulation goals while on ECMO were an aPTT of 45-90 seconds and an ACT of 250-300 seconds. Oxygenation and right ventricular function improved over the next 4 days. Argatroban infusion rates while on ECMO ranged from 0.1 to 1mcg/kg/minute. Throughout ECMO numerous elevated clotting times (ACT > 1000 seconds, aPTT > 124 seconds) resulted in the need to hold the argatroban infusion four times; totaling 77 hours or 64% of the time on therapy. Although holds were warranted for supratherapeutic clotting times; numerous factors other than argatroban were elevating the aPTT and ACT including hepatic impairment, DIC, hemodilution and hypothermia. The patient was successfully de-cannulated and subsequently returned to OR for sternal closure and placement of a Greenfield filter. Intraoperatively an enlarging right atrial thrombus; 3 cm wide by 6cm long was removed via right open atriotomy. After return to the ICU the patient developed bi-ventricular failure and expired. This case illustrates the challenges of argatroban dosing in ECMO, the limitations of argatroban monitoring tests, and the potential life threatening thrombotic consequences of HIT during argatroban infusion interruption despite therapeutic clotting time tests.

Unanticipated intra-operative finding of pulmonary artery tumour thromboembolism during radical nephrectomy and caval thrombectomy: Case report and management

We report a case of an unanticipated intra-operative transesophageal echocardiography (TEE) finding of pulmonary artery thromboembolism in a 72-year-old woman being prepared for radical nephrectomy and caval thrombectomy. Upon intra-operative TEE to evaluate the extent of caval thrombus, we found a pulmonary artery tumour thromboembolism in an otherwise asymptomatic patient after induction and prior to surgery. A chest computed tomography confirmed a large saddle tumour thromboembolus. A multidisciplinary approach was used to facilitate radical nephrectomy with caval thrombectomy and pulmonary artery thromboembolectomy. This case shows the importance of adequate perioperative imaging and use of intra-operative TEE to evaluate the extent of disease. To our knowledge, we are the first to present a case of RCC with cava tumour thrombus in which the pulmonary artery tumour thromboembolism was detected incidentally on intraoperative TEE.

Pancreatic Endocrine Tumour with Disseminated Pulmonary Thromboembolism in an Owl Monkey (Aotus nancymae)

Pulmonary thromboembolism associated with pancreatic endocrine neoplasia is extremely uncommon in man and animals. Post-mortem examination of an adult owl monkey (Aotus nancymae) revealed extensive pulmonary arterial thromboembolism and a well-demarcated mass attached to the pancreas. Microscopically, the mass consisted of areas of interstitial fibrosis with loss of acini and islets and replacement by nests and sheets of polygonal cells with amphophilic cytoplasm, an eccentric round nucleus with stippled chromatin and, in some cells, with a single prominent eccentric nucleolus. Clusters of these cells were noted within vessels and adjacent lymph nodes. The cells did not express S100 or insulin, but were labelled strongly with SP-1/chromogranin. Rare individual cells expressed glucagon and somatostatin. A few cells in pulmonary thrombi/emboli and the adjacent lymph node also expressed SP-1/chromogranin. Based on cell morphology, location and immunohistochemistry the tumour was classified as pancreatic endocrine (islet cell) carcinoma with metastasis to regional lymph nodes and lung.

Life-threatening Migration of ALN Inferior Vena Cava Filter to Right Ventricle

A 40-year-old man underwent emergent pulmonary artery thromboembolectomy for pulmonary artery thromboembolism, and an ALN filter was placed in the inferior vena cava immediately after the operation. He had sudden ventricular tachycardia with dyspnea on postoperative day 6. An emergent operation was successfully performed, and the ALN filter was observed at the tricuspid valve with a large amount of the thrombus. Migration of the inferior vena cava filter to the right ventricle is a life-threatening complication that may result from residual deep vein thrombosis.

The prevalence of VKORC1 1639 G&gt;A and CYP2C9*2*3 genotypes in patients that requiring anticoagulant therapy in Turkish population

The aim was to investigate the prevalence of VKORC1 and CYP2C9 genotypes in patients requiring anticoagulant therapy in two different region's populations of Turkey. The recent cohort included 292 patients that needed anticoagulant therapy, and who had a history of deep vein thrombosis and/or pulmonary artery thromboembolism. Genomic DNA was isolated from peripheral blood samples and the StripAssay reverse hybridization or Real Time PCR technique was used for genotype analysis. Genotypes for CYP2C9 were detected as follows: 165 (56.5 %) for CYP2C9*1/*1, 67 (23.0 %) for CYP2C9*1/*2, 25 (8.6 %) for CYP2C9*1/*3, 9 (3.0 %) for CYP2C9*2/*2, 21 (7.2 %) for CYP2C9*2/*3, 5(1.7 %) for CYP2C9*3/*3 for CYP2C9 and the allele frequencies were: 0.723 for allele*1, 0.182 for allele*2 and 0.095 for allele*3 respectively. Genotypes for VKORC1 were detected as follows: 64 (21.9 %) for GG, 220 (75.4 %) for GA and 8 (2.7 %) for AA alleles. The G allele frequency was detected as 0.596, and the A allele frequency was 0.404. The VKORC1 1639 G>A and CYP2C9 mutation prevalence and allele frequency of the current results from two different populations (Sivas and Canakkale) showed similarly very variable profiles when compared to the other results from the Turkish population.