ABSTRACT
BACKGROUND@#Pulmonary thrombosis embolism (PTE) is one of the most severe complications of perioperative radical mastectomy. Massive PTE is often accompanied by shock and hypotension which is characterized by rapid progression and high mortality. There is no standard for the treatment of these patients, which is thoracic surgery, and it is a critical issue in the thoracic surgeons. This article summarizes and analyzes the treatment of two patients with high-risk PTE at the early stage of postoperative lung cancer in our hospital. In addition, we discusses the diagnosis and treatment strategies of these cases to provide a reference for the thoracic surgeons.@*METHODS@#We presented two patients with high-risk PTE at the early stage after thoracic surgery for radical surgery in our hospital back in 2017. One case was treated with intravenous venous interventional thrombolysis, and the other was treated with thrombolysis alone. The treatment effect of two patients and the complications during the treatment has been recorded to detail and summarized.@*RESULTS@#Both patients were female who aged 66 and 61 years old. The time point of pulmonary embolism was 48 h and 45 h after operation, and the time of interventional thrombolysis was 70 minutes and 50 minutes after onset respectively. After 120 minutes and 100 minutes, the drainage after interventional thrombolysis was 4,690 mL and 520 mL respectively. The hospitalization time after thrombolysis was 21 days and 14 days respectively. There was no obvious complication through a follow-up of 6 months.@*CONCLUSIONS@#Early postoperative acute massive pulmonary embolism in lung cancer should be treated with pulmonary interventional thrombolysis as soon as possible. Compared with intravenous thrombolysis, pulmonary interventional thrombolysis shows accuracy, easy controlling of dosage, fast curative effect and low bleeding risk.
Subject(s)
Female , Humans , Middle Aged , Lung Neoplasms , General Surgery , Postoperative Complications , Therapeutics , Pulmonary Embolism , Therapeutics , Retrospective Studies , Thoracic Surgery, Video-Assisted , Thrombolytic TherapyABSTRACT
Patients with massive pulmonary embolism may present with severe dyspnea at rest, syncope, or cardiac arrest. Early diagnosis and treatment are essential to reduce mortality; however, patient-specific factors can influence the hemodynamic effect of pulmonary embolism. Here, we present a case of massive pulmonary embolism masked by a ventricular septal defect in a 73-year-old female.
Subject(s)
Aged , Female , Humans , Dyspnea , Early Diagnosis , Heart Arrest , Heart Septal Defects, Ventricular , Hemodynamics , Masks , Mortality , Pulmonary Embolism , SyncopeABSTRACT
La alta mortalidad de los pacientes con tromboembolismo pulmonar masivo de alto riesgo amerita un enfoque terapéutico enérgico e invasivo que incluya la embolectomía pulmonar quirúrgica en aquellos pacientes con contraindicación para trombolisis o trombolisis fallida. Describimos un caso de tromboembolismo pulmonar masivo de alto riesgo que recibió tratamiento quirúrgico en vez de trombolisis debido a que al momento del diagnóstico presentaba un trombo móvil a través de un foramen oval permeable con altísima posibilidad de embolismo paradójico arterial.
High mortality rate associated with massive pulmonary embolism requires an aggressive invasive approach including surgical pulmonary embolectomy when thrombolytic therapy has failed or is contraindicated. We describe a case of high-risk massive pulmonary embolism who underwent surgical treatment due to the presence of a mobile intracardiac clot in a patent foramen ovale, and the possible risk of paradoxical arterial embolism.
Subject(s)
Female , Humans , Middle Aged , Foramen Ovale, Patent/complications , Pulmonary Embolism/etiology , Echocardiography, Transesophageal , Embolectomy , Foramen Ovale, Patent , Foramen Ovale, Patent/surgery , Pulmonary Artery/surgery , Pulmonary Embolism , Tomography, X-Ray ComputedABSTRACT
La tromboembolia de pulmón es una patología cardiovascular frecuente, con una incidencia de 1/1.000 en los Estados Unidos y una mortalidad que alcanza el 15% en los tres meses siguientes a su diagnóstico. Esta mortalidad aumenta cinco veces en los pacientes que desarrollan shock. A pesar de su incidencia y morbimortalidad elevadas, el tratamiento habitual no ha variado sustancialmente en los últimos años y aun a pesar de los avances en las terapias con trombolíticos o la endarterectomía quirúrgica, la tasa de mortalidad se mantiene muy elevada en los pacientes con tromboembolia pulmonar masiva. Recientemente se ha comenzado a utilizar terapias de trombectomía percutánea, que abren una nueva opción terapéutica que debe considerarse si se dispone de los medios necesarios. En esta presentación se describen dos casos de tromboembolia pulmonar masiva tratados con trombectomía reolítica.
Pulmonary embolism (PE) is a common cardiovascular disease with an incidence of 1/1000 in the United States and a mortality rate of 15% three months after been diagnosed. Mortality is five times greater in patients with shock. Despite its high incidence, morbidity and mortality, the treatment has not varied in the last years, and in patients with massive PE mortality still remains high even with the current improvements in thrombolytic therapy or surgical endarterectomy. The recent introduction of percutaneous thrombectomy techniques has opened a new therapeutic option that should be considered when available. We describe two case reports of massive pulmonary embolism treated with rheolytic thrombectomy.
ABSTRACT
Introdução. A embolia pulmonar é comum e pode estar associada a morbimortalidades significativas. O tratamento convencional é feito com anticoagulação, porém os trombolíticos têm sido indicados em condições graves com instabilidade hemodinâmica. Objetivo. Revisar o tratamento da tromboembolia pulmonar extensa e comprometimento ventricular direito, associada à instabilidade hemodinâmica. Discutir as evidências no tratamento dessa morbidade, com lesão do ventrículo direito, sem instabilidade hemodinâmica. Discussão. O uso de trombólise em pacientes com tromboembolia pulmonar e instabilidade hemodinâmica está bem estabelecido. Entretanto, há controvérsias sobre sua indicação em pacientes acometidos e disfunção ventricular direita sem instabilidade hemodinâmica persistente. Conclusão. Atualmente, não há evidências que amparem o uso generalizado de trombolíticos em pacientes com quadro agudo e disfunção ventricular direita sem instabilidade hemodinâmica.
Introduction. Pulmonary embolism is a common disease that could be related to significant morbidity and mortality. Anticoagulation is the standard treatment, but thrombolytics have been indicated for the disease with hemodynamic instability. Objective. Review the treatment of pulmonary embolism with hemodynamic instability and discuss the evidences of using thrombolysis for treating pulmonary embolism with right ventricular dysfunction and without hemodynamic instability. Discussion. Thrombolysis is well established for patients with pulmonary embolism and hemodynamic instability. However, indication to use thrombolytics for treating pulmonary embolism with right ventricular dysfunction and without hemodynamic instability is still a doubt. Conclusion. Until now, there is no evidence to support the routine use of thrombolysis for patients with the disease and right ventricular dysfunction, but without hemodynamic instability.