1/18. Visualization of functional improvement by 123I-IMP lung SPET after thromboendarterectomy for chronic pulmonary embolism.We report on six patients with chronic pulmonary embolism who underwent 123I-IMP and 99Tcm-MAA lung SPET before and after thromboendarterectomy. 123I-IMP lung SPET can assess the viability of lung parenchyma, because it is a non-particulate agent that accumulates in the endothelial membranes of pulmonary capillaries. Chronic pulmonary thromboembolism accompanied by pulmonary hypertension has a poor prognosis that may be improved only by thromboendarterectomy. We compared 123I-IMP and 99Tcm-MAA lung SPET in terms of functional improvement after such surgery. After thromboendarterectomy, all six patients were functionally improved, according to the criteria of the new york heart association. The pre- and post-surgery percentage of vascular obstruction did not differ significantly with 99Tcm-MAA lung SPET (44.8 /- 11.2% and 32.5 /- 15.6% pre- and post-surgery, respectively). In contrast, 123I-IMP lung SPET revealed a significant pre- versus post-surgery difference (15.5 /- 9.5% and 3.3 /- 5.9% pre- and post-surgery, respectively). 123I-IMP lung SPET could be useful for evaluating thromboendarterectomy because pulmonary parenchymal viability owing to arterial microvasculature can be estimated.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
2/18. A successful case of pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension with a thrombus in the right ventricle.Chronic thromboembolism is a frequent cause of progressive hypertension and carries a poor prognosis. Medical treatment is not effective and surgery provides the only potential for a cure at present. We herein report a successful case of thromboendarterectomy treated via a median sternotomy with intermittent circulatory arrest. A 43-year-old man was admitted to our hospital complaining of progressive dyspnea, edema of the lower extremities, and a fever with an unknown origin. A subsequent definitive evaluation showed him to be suffering from surgically accessible chronic thromboembolic pulmonary hypertension with a thrombus in the right ventricle. He underwent a pulmonary thromboendarterectomy and thrombectomy via a median sternotomy with intermittent circulatory arrest on November 24, 1994. Postoperatively he showed a marked improvement in his hemodynamic status and blood gas analysis. He has also returned to work with no trouble. Deep vein thrombosis appeared to be the pathogenesis of this case, but we could not find the origin of his unknown fever. He is currently being controlled by treatment with methylprednisolone as before.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
3/18. Successful pulmonary thromboendarterectomy in a patient with Klippel-Trenaunay syndrome.Klippel-Trenaunay syndrome (KTS) is a congenital disorder characterized by a triad of cutaneous vascular nevi, soft tissue or bony hypertrophy, and varicose veins or venous malformations involving one or more extremities. An incidence of venous thromboembolism of up to 22% has been reported in this disorder. Also reported is the development of chronic thromboembolic pulmonary hypertension (CTEPH) and subsequent death from right ventricular failure. We report the first patient with KTS to undergo a successful pulmonary thromboendarterectomy for CTEPH.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
4/18. Unilateral chronic thromboembolic pulmonary disease associated with combined inherited thrombophilia.Chronic thromboembolic pulmonary hypertension (CTEPH) is considered to be an extreme variant of pulmonary thromboembolism. The underlying mechanisms for the failure of thrombus resolution are still unclear. In looking for inherited thrombophilia, an association with a lupus anticoagulant has been described repeatedly, and single cases of anticoagulant deficiencies (ie, antithrombin [AT], protein c, and protein s) have been reported. We describe a young patient with type I AT deficiency, the heterozygous prothrombin G20210A mutation, and unilateral chronic thromboembolic pulmonary disease presenting after a single thrombotic event. Pulmonary vascular patency was restored successfully by surgical pulmonary thromboendarterectomy. This case is unique because unilateral CTEPH is extremely uncommon, and it illustrates the severe clinical sequelae of the cosegregation of inherited thrombophilic defects.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
5/18. Chronic pulmonary thromboembolism.Chronic pulmonary thromboembolism is a rare but treatable cause of pulmonary hypertension. We are describing two patients with limited mobility and dyspnoea. Neither of the patients had clinical evidence of deep vein thrombosis. A high level of clinical suspicion is required for the diagnosis. Spiral CT scan establishes the diagnosis avoiding the need for pulmonary angiography. Surgical endarterectomy is the treatment of choice. life-long anticoagulation therapy is recommended for patients in whom surgery cannot be performed. Untreated, the condition carries a high mortality.- - - - - - - - - - ranking = 5keywords = thromboembolism (Clic here for more details about this article) |
6/18. Successful pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension associated with anticardiolipin antibodies: report of a case.Chronic pulmonary thromboembolism with pulmonary hypertension is a rare but most unique syndrome in the broad spectrum of pulmonary embolism. This report describes a successful pulmonary thromboendarterectomy performed for a totally occluded right pulmonary artery on a 43 year old man who presented with positive cardiolipin antibodies. The surgery was performed through a median sternotomy with cardiopulmonary bypass and intermittent periods of deep hypothermic circulatory arrest. We are convinced that this method allows for complete removal of the thrombotic obstruction and should be the procedure of choice for patients with very proximal obstruction of a pulmonary artery.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
7/18. Antiphospholipid antibody thrombosis. Another source of chronic wounds.Antiphospholipid antibody thrombosis syndrome is currently not well known and probably underdiagnosed. The risk it presents for recurrent thromboembolism is both life threatening and chronic. Because patients often develop long-standing wounds, it is important for the wound care nurse to identify clients suspect for the disease. Several theories exist speculating on the mechanism of thrombosis involving antiphospholipid antibodies, and each focuses on changes at the interface between the vessel, cell wall membrane, and its interaction with circulating antibodies. As wound care nurses, we should consider antiphospholipid antibody thromboses whenever encountering a recalcitrant wound without obvious underlying cause. thrombosis can occur anywhere, although 41% of presentations are cutaneous. Recurrent deep vein thrombosis with coexisting venous insufficiency can lead to a missed diagnosis of antiphospholipid thrombosis syndrome, despite evidence of pain and tissue necrosis that is typical of the disease. In any event, long-standing nonhealing wounds are always a signal to revise a diagnosis and seek alternative causes for failure of healing.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
8/18. Chronic thromboembolic pulmonary hypertension--diagnosed on spiral CT angiography.Chronic thromboembolic pulmonary hypertension (CTEPH) is a part of the spectrum of venous thromboembolism in which pulmonary thrombus fails to resolve, resulting in occlusion of the major pulmonary artery. diagnosis of this disease is important as it is potentially curable by pulmonary thromboendarterectomy. A case of CTEPH diagnosed non-invasively on spiral computerized (CT) pulmonary angiography is reported.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
9/18. Management of left atrial endocardium after extensive thrombectomy.thrombosis at the left atrium is a common phenomenon in patients with chronic mitral valve disease and atrial fibrillation. When thrombus organizes and evolves into chronic phase, clean thrombectomy can become a challenge during heart surgery because of dense adhesions and the lack of clean cleavage plane. Leaving residual thrombotic material or roughened endocardial surface after thrombectomy could be a potential source for further thrombosis and a nidus for thromboembolism. We recently managed such a patient successfully using extensive thrombectomy and endocardial coverage with a fresh autologous pericardial patch.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
10/18. Pulmonary thromboembolism in AIDS patient with chronic venous insufficiency, pulmonary tuberculosis and breast cancer: a case report and pathophysiology review.Recent literature reports thrombotic episodes occurring in patients with hiv infection associated with other abnormalities including neoplasms and infections predisposing to a hypercoagulable state. We report a 47-year-old woman who developed pulmonary thromboembolism in association with hiv infection, pulmonary tuberculosis and breast cancer. She was treated with rifampin, isoniazid, pyrazinamide; heparin, phenprocoumon, zidovudine, lamivudine and efavirenz. Acid fast bacilli were visualized in a sputum smear and three months after, mycobacterium tuberculosis was isolated from lymph node biopsy during a episode of immune reconstitution. The isolated mycobacteria showed sensitivity to all first-line drugs. hiv infection, breast cancer and pulmonary tuberculosis have several mechanisms that induce hypercoagulable state and can lead to thromboembolic complications. Pulmonary thromboembolism in this patient was a diagnostic challenge because of all the other severe diseases that she experienced at the same time.- - - - - - - - - - ranking = 6keywords = thromboembolism (Clic here for more details about this article) |
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