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1.
Arch. cardiol. Méx ; 92(3): 312-319, jul.-sep. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1393825

ABSTRACT

Abstract Background: Pulmonary thromboendarterectomy is the current treatment of choice in patients with chronic thromboembolic pulmonary hypertension. The objective of the present study was to analyze the clinical and hemodynamic outcomes and the risk factors for mortality in a cardiovascular center in Colombia. Methods: Cohort study, conducted between 2001 and 2019. All operated patients were included in the study. Risk factors associated with mortality were established by means of a multivariate regression using the COX method and survival was established using the Kaplan-Meier method. p < 0.05 was considered statistically significant. Results: Seventy-three patients were operated. Median age was 51 years, 55% of females, 79% had functional Class III and IV. The mean pulmonary arterial pressure was 50 mmHg and 640 dyn.s.cm−5 for pulmonary vascular resistance (PVR). After the intervention, there was a decrease in mean pulmonary artery pressure (p ≤ 0.001) and in PVR (p = 0.357); 21% had evidence of residual pulmonary hypertension. Only 8% and 6% continued with functional Class III and IV at 6 and 12 months, respectively. There were 15 deaths (19.1%; 12% at 30 days). The factors associated with mortality were the diastolic diameter of the right ventricle measured postoperatively (hazard ratio [HR] 10.88 95% confidence interval [CI] 1.97-62, p = 0.007), time of invasive mechanical ventilation (HR 1.06 95% CI 1.02-1.09 p = 0.004), and the presence of complications during the surgical procedure (HR 5.62 95% CI 1.94-16.22 p = 0.001). Conclusions: Pulmonary thromboendarterectomy is associated with excellent clinical and hemodynamic outcomes. The mortality risk factors found are not those usually described in the literature.


Resumen Antecedentes: La tromboendarterectomía pulmonar es el tratamiento de elección actual en pacientes con hipertensión pulmonar tromboembólica crónica. El objetivo del presente estudio fue analizar los resultados clínicos y hemodinámicos y los factores de riesgo de mortalidad en un centro cardiovascular de Colombia. Métodos: Estudio de cohorte entre 2001 y 2019. Se incluyeron todos los pacientes operados. Los factores de riesgo asociados a la mortalidad se establecieron mediante una regresión multivariante mediante el método COX y la supervivencia se estableció mediante el método de Kaplan-Meier. Los valores de p < 0.05 se consideraron estadísticamente significativos. Resultados: se operaron 73 pacientes. La mediana de edad fue de 51 años, 55% mujeres, 79% tenían clase funcional III y IV. La presión arterial pulmonar media fue de 50 mmHg y 640 dyn.s.cm−5 para la resistencia vascular pulmonar. Después de la intervención, hubo una disminución en la presión arterial pulmonar media (p ≤ 0.001) y en la resistencia vascular pulmonar (p = 0.357). El 21% tenía evidencia de hipertensión pulmonar residual. Solo el 8% y el 6% continuaron con clase funcional III y IV a los 6 y 12 meses respectivamente. Hubo 15 muertes (19.1%; 12% a los 30 días). Los factores asociados con la mortalidad fueron el diámetro diastólico del ventrículo derecho medido en el postoperatorio (HR 10.88 IC 95% 1.97-62, p = 0.007), el tiempo de ventilación mecánica invasiva (HR 1.06 IC 95% 1.02-1.09 p = 0.004) y el presencia de complicaciones durante el procedimiento quirúrgico (HR 5.62 IC 95% 1.94-16.22 p = 0.001). Conclusiones: La tromboendartectomía pulmonar se asocia con excelentes resultados clínicos y hemodinámicos. Los factores de riesgo de mortalidad encontrados no son los habitualmente descritos en la literatura.

2.
Rev. bras. cir. cardiovasc ; 37(4): 584-586, Jul.-Aug. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1394724

ABSTRACT

ABSTRACT Endomyocardial fibrosis is a neglected tropical disease that leads to restrictive cardiomyopathy. Its etiopathogenis is unclear and involves the progression of 3 stages of the disease. Compared with echocardiography, cardiac magnetic resonance imaging shows better apical visualization of obliteration and thrombus and provides an early diagnosis. However, there is no specific drug therapy, although surgery can increase survival. Therefore, surgical resection of the fibrous and thickened endocardium is recommended for symptomatic patients. The risk of mortality increases as the ratio of endocardial fibrous tissue per body surface rises. The aim of this manuscript is to describe the surgical management of the right-sided endomyocardial fibrosis mimicking tumor with recurrent pulmonary embolism.

3.
Rev. chil. enferm. respir ; 38(2)jun. 2022.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1407773

ABSTRACT

Resumen Introducción: El aumento de la concentración de dímero-D en pacientes COVID-19 se ha asociado a mayor gravedad y peor pronóstico; sin embargo, su rol en predecir el diagnóstico de tromboembolismo pulmonar (TEP), aún es incierto. Objetivo: Evaluar la utilidad del dímero-D plasmático en el diagnóstico de TEP en pacientes con COVID-19. Pacientes y Métodos: Estudio observacional analítico. Se incluyó a pacientes COVID-19 que tenían una angiotomografía computada de tórax (AngioTAC). Se registraron datos clínicos, niveles plasmáticos de dímero-D de ingreso y previo al momento de realizar la AngioTAC. Se identificó la presencia o ausencia de TEP. Resultados: Se incluyeron 163 pacientes; 37(23%) presentaron TEP. Al comparar la serie de pacientes con TEP versus sin TEP, no se encontraron diferencias significativas en características clínicas, ni mortalidad. Hubo diferencias significativas en el nivel plasmático del dímero-D previo a realizar la AngioTAC (3.929 versus 1.912 μg/L; p = 0,005). El área bajo la curva ROC del dímero-D para TEPfue de 0,65. El mejor punto de corte del dímero-D fue de 2.000 μg/L, con una baja sensibilidad y valor predictivo positivo. El valor de corte con el mejor valor predictivo negativo (VPN)fue de 900 μg/L (96%), el cual fue mejor que la estrategia de corte de dímero D ajustado por edad (VPN 90%). Conclusión: La capacidad discriminativa del dímero D para diagnosticar TEP fue baja. En cambio, el dímero D mantiene un alto valor predictivo negativo para descartar TEP, el cual es mayor al valor descrito clásicamente en los pacientes no COVID.


Introduction: Increased D-dimer concentration in COVID-19 patients has been associated with greater severity and worse prognosis; however its role in predicting the diagnosis of pulmonary thromboembolism (PTE), is still uncertain. Objective: To evaluate the usefulness of plasma D-dimer in the diagnosis of PTE in patients with COVID-19. Method: Analytical observational study. COVID-19 patients who had a chest computed tomography angiography (CTA) were included. Clinical data, Ddimer plasma levels on admission and prior to CTA were recorded. The presence or absence of PTE was identified. Results: 163 patients were included, 37 (23%) presented PTE. After comparing the series of patients with PTE versus the series without PTE, no significant differences were found in clinical characteristics or mortality. There were significant differences in the plasma level of D-dimer prior to performing CTA (3,929 μg/L versus. 1,912 μg/L; p = 0.005). The area under the D-dimer ROC curve for PTEprediction was 0.65. The best D-dimer cutoffpoint was 2.000μg/L, with a low sensitivity and positivepredictive value. The cutoff value with the best negativepredictive value (NPV) was 900 μg/L (96%), which was better than the age-adjusted D-dimer cutoff strategy (NPV 90%). Conclusion: The discriminative ability of D-dimer to diagnose PTE was low. In contrast, D-dimer maintains a high negative predictive value to rule out PTE, which is higher than the value classically described in non-COVID patients.

4.
Rev. colomb. cardiol ; 29(3): 373-377, mayo-jun. 2022. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1407992

ABSTRACT

Resumen Los sarcomas son neoplasias primarias, cuya ubicación es rara en grandes vasos y excepcional en las venas pulmonares. Los dos tipos más frecuentes en las venas pulmonares son el leiomiosarcoma y el fibrosarcoma, con una distribución alrededor de la cuarta a la quinta décadas de vida, un pronóstico de 23 meses y 60% de metástasis al momento del diagnóstico. La presentación clínica es inespecífica ya que simula situaciones como embolia pulmonar, falla cardiaca descompensada y masa en la aurícula izquierda. Para su diagnóstico se cuenta con diferentes herramientas, como la ecocardiografía, la tomografía computarizada, la angiografía coronaria, la resonancia magnética y la tomografía por emisión de positrones (PET TC). El tratamiento incluye resección quirúrgica radical, manejo adyuvante con quimioterapia y radioterapia, e incluso, en casos seleccionados, trasplante de corazón. Se presenta el caso de una paciente con diagnóstico inicial de embolia pulmonar, con un episodio de edema pulmonar secundario a masa en la aurícula izquierda y extensión de un sarcoma de vena pulmonar derecha, con desenlace fatal. Se aporta a la literatura con el caso y la revisión de tema.


Abstract Sarcomas are primary neoplasms, whose location is rare in large vessels and in the pulmonary veins is exceptional. The two most frequent types in the pulmonary vein are leiomyosarcoma and fibrosarcoma, distribution around 4 and 5 decades of life, with a prognosis of 23 months and 60% metastasis at the time of diagnosis. The clinical presentation is nonspecific simulating situations such as pulmonary embolism, decompensated heart failure and mass in the left atrium. Different tools are available for its diagnosis, like echocardiography, computed tomography, coronary angiography, magnetic resonance imaging and PET CT. Treatment includes radical surgical resection, adjuvant therapy with chemotherapy, and radiation therapy, even heart transplantation in selected cases. It is presented the case of a patient with an initial diagnosis of pulmonary embolism, with an episode of pulmonary edema secondary to a mass in the left atrium, extension of a sarcoma of the right pulmonary vein, with a fatal outcome. We contributed to the literature with the case and review of theme.

5.
Más Vita ; 4(2): 86-92, jun. 2022. ilus
Article in Spanish | LILACS, LIVECS | ID: biblio-1392119

ABSTRACT

La pandemia de COVID-19 actualmente ha demostrado la importancia de una evaluación y un manejo agresivos, al considerar su exposición como una enfermedad viral muy trasmisible que tiene efectos multisistémicos y una alta tasa de mortalidad. Es así que el diagnóstico y el tratamiento de la embolia pulmonar, son desafiantes en circunstancias habituales. Objetivo: Describir un caso clínico de tromboembolismo pulmonar masivo en covid-19. Reporte de Caso: Paciente de sexo masculino 42 años con antecedentes patológico personales de hipertensión arterial con prueba rápida para SARS COV-2 IGG e IGM positivo. Resultados: Se estima que cada año hay 900.000 casos de tromboembolismo venoso (TEV) en los Estados Unidos, 150.000 a 250.000 hospitalizaciones relacionadas con la embolia pulmonar (EP) y 60.000 a 100.000 muertes, lo que la convierte en la tercera causa más común de enfermedades cardiovasculares. Conclusión: Una vez que se diagnostica una embolia pulmonar, es necesaria la estratificación del riesgo para definir el manejo adecuado. Los tratamientos disponibles al momento pueden variar desde anticoagulación sola, trombólisis dirigida por catéter, trombólisis sistémica de dosis completa, embolectomía con catéter, embolectomía quirúrgica y soporte circulatorio mecánico como oxigenación por membrana extracorpórea (ECMO)(AU)


The COVID-19 pandemic has currently demonstrated the importance of aggressive evaluation and management, considering its exposure as a highly transmissible viral disease that has multisystem effects and a high mortality rate. Thus, the diagnosis and treatment of pulmonary embolism are challenging under usual circumstances. Objective: To describe a clinical case of massive pulmonary thromboembolism in covid-19. Case Report: A 42-year-old male patient with a personal pathological history of arterial hypertension with a positive rapid test for SARS COV-2 IGG and IGM. Results: There are an estimated 900,000 cases of venous thromboembolism (VTE) in the United States each year, 150,000 to 250,000 pulmonary embolism (PE)-related hospitalizations, and 60,000 to 100,000 deaths, making it the third most common cause of pulmonary embolism. cardiovascular diseases. Conclusion: Once a pulmonary embolism is diagnosed, risk stratification is necessary to define the appropriate management. Currently available treatments may range from anticoagulation alone, catheter-directed thrombolysis, full-dose systemic thrombolysis, catheter embolectomy, surgical embolectomy, and mechanical circulatory support such as extracorporeal membrane oxygenation (ECMO)(AU)


Subject(s)
Humans , Male , Adult , Pulmonary Embolism , Severe Acute Respiratory Syndrome , COVID-19 , Pneumonia , Cardiovascular Diseases , Communicable Diseases , Mortality , Hospitalization
6.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1408193

ABSTRACT

RESUMEN Introducción: La enfermedad tromboembólica venosa es un proceso grave y mortal, considerado un problema de salud a escala mundial. Objetivo: Caracterizar la morbi-mortalidad por enfermedad tromboembólica venosa en el Hospital Universitario "Arnaldo Milián Castro". Métodos: Se realizó un estudio descriptivo retrospectivo de corte transversal a una muestra de 290 casos atendidos en el Hospital Universitario "Arnaldo Milián Castro" de Villa Clara, entre febrero de 2014 y febrero de 2016. Las variables fueron: edad, sexo, factores de riesgo, forma de presentación de la enfermedad y tipo de diagnóstico. Resultados: Se observó un predominio del sexo femenino y de los pacientes mayores de 70 años, independientemente del sexo y la inmovilidad como factor de riesgo. La trombosis venosa profunda del sector íleo-femoral fue la forma de presentación más común. El diagnóstico clínico primó, aunque el tromboembolismo pulmonar, como la complicación principal, se diagnosticó por necropsia. La mayor cantidad de trombosis venosa profunda se registró en el Servicio de Angiología, mientras que las muertes por embolia pulmonar predominaron en el Servicio de Terapia Intensiva. El tratamiento médico más utilizado fue la heparina sódica más warfarina; el profiláctico se realizó solo en el 24,7 % de los casos. La heparina sódica se utilizó más en los servicios de Terapia Intensiva. Conclusiones: La enfermedad tromboembólica venosa fue la principal causa de muerte prevenible en el hospital, lo que sugiere que la profilaxis antitrombótica debe resultar una práctica esencial en los pacientes hospitalizados.


ABSTRACT Introduction: Venous thromboembolic disease is a serious and fatal process considered a health problem on a global scale. Objective: Characterize morbidity and mortality due to venous thromboembolic disease at "Arnaldo Milián Castro" University Hospital. Methods: A retrospective descriptive cross-sectional study was conducted on a sample of 290 cases treated at "Arnaldo Milián Castro" University Hospital in Villa Clara between February 2014 and February 2016. The variables were: age, sex, risk factors, form of presentation of the disease and type of diagnosis. Results: A predominance of the female sex and patients over 70 years of age was observed, regardless of sex and immobility as risk factors. Deep vein thrombosis of the ileus-femoral sector was the most common form of presentation. Clinical diagnosis prevailed, although pulmonary thromboembolism, as the main complication, was diagnosed by necropsy. The highest amount of deep vein thrombosis was recorded in the Angiology Service, while deaths from pulmonary embolism predominated in the Intensive Care Service. The most commonly used medical treatment was sodium heparin plus warfarin; prophylaxis was performed only in 24.7% of cases. Sodium heparin was more used in Intensive Care services. Conclusions: Venous thromboembolic disease was the leading cause of preventable death in the hospital, suggesting that antithrombotic prophylaxis should be an essential practice in hospitalized patients.

7.
Arq. bras. cardiol ; 118(4): 756-765, Apr. 2022. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1374346

ABSTRACT

Resumo Fundamento Demonstrou-se recentemente que a aplicação de ultrassom de alta energia com microbolhas, técnica conhecida como sonotrombólise, causa a dissolução de trombos intravasculares e aumenta a taxa de recanalização angiográfica no infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAM-CSST). Objetivo Avaliar o efeito da sonotrombólise nos índices de motilidade e perfusão miocárdicas em pacientes com IAM-CSST, utilizando a ecocardiografia com perfusão miocárdica em tempo real (EPMTR). Método Uma centena de pacientes com IAM-CSST foram randomizados em dois grupos: Terapia (50 pacientes tratados com sonotrombólise e angioplastia coronária primária) e Controle (50 pacientes tratados com angioplastia coronária primária). Os pacientes realizaram EPMTR para analisar a fração de ejeção do ventrículo esquerdo (FEVE), o índice de escore de motilidade segmentar (IEMS) e o número de segmentos com defeito de perfusão miocárdica, 72 horas após o IAM-CSST e com 6 meses de acompanhamento. Foi considerado significativo p < 0,05. Resultados Pacientes tratados com sonotrombólise apresentaram FEVE mais alta que o grupo Controle em 72 horas (50 ± 10% vs. 44 ± 10%; p = 0,006), e essa melhora foi mantida em seis meses (53 ± 10% vs. 48 ± 12%; p = 0,008). O IEMS foi similar nos grupos Terapia e Controle em 72 horas (1,62 ± 0,39 vs. 1,75 ± 0,40; p = 0,09), mas tornou-se menor no grupo Terapia em 6 meses (1,46 ± 0,36 vs. 1,64 ± 0,44; p = 0,02). O número de segmentos com defeito de perfusão não foi diferente entre os grupos em 72 horas (5,92 ± 3,47 vs. 6,94 ± 3,39; p = 0,15), mas ficou menor no grupo Terapia em 6 meses (4,64 ± 3,31 vs. 6,57 ± 4,29; p = 0,01). Conclusão A sonotrombólise em pacientes com IAM-CSST resulta na melhora dos índices de motilidade e perfusão ventricular ao longo do tempo.


Abstract Background It has recently been demonstrated that the application of high-energy ultrasound and microbubbles, in a technique known as sonothrombolysis, dissolves intravascular thrombi and increases the angiographic recanalization rate in patients with ST-segment-elevation myocardial infarction (STEMI). Objective To evaluate the effects of sonothrombolysis on left ventricular wall motion and myocardial perfusion in patients with STEMI, using real-time myocardial perfusion echocardiography (RTMPE). Methods One hundred patients with STEMI were randomized into the following 2 groups: therapy (50 patients treated with sonothrombolysis and primary coronary angioplasty) and control (50 patients treated with primary coronary angioplasty). The patients underwent RTMPE for analysis of left ventricular ejection fraction (LVEF), wall motion score index (WMSI), and number of segments with myocardial perfusion defects 72 hours after STEMI and at 6 months of follow-up. P < 0.05 was considered statistically significant. Results Patients treated with sonothrombolysis had higher LVEF than the control group at 72 hours (50% ± 10% versus 44% ± 10%; p = 0.006), and this difference was maintained at 6 months of follow-up (53% ± 10% versus 48% ± 12%; p = 0.008). The WMSI was similar in the therapy and control groups at 72 hours (1.62 ± 0.39 versus 1.75 ± 0.40; p = 0.09), but it was lower in the therapy group at 6 months (1.46 ± 0.36 versus 1.64 ± 0.44; p = 0.02). The number of segments with perfusion defects on RTMPE was similar in therapy and control group at 72 hours (5.92 ± 3.47 versus 6.94 ± 3.39; p = 0.15), but it was lower in the therapy group at 6 months (4.64 ± 3.31 versus 6.57 ± 4.29; p = 0.01). Conclusion Sonothrombolysis in patients with STEMI resulted in improved wall motion and ventricular perfusion scores over time.

9.
Medicina (B.Aires) ; 82(1): 21-27, feb. 2022. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1365124

ABSTRACT

Resumen La enfermedad producida por el COVID-19 ha generado un problema sanitario mundial sin precedentes. La infección se considera como un potencial factor de riesgo para desarrollar complica ciones tromboembólicas, principalmente, embolia pulmonar, infarto de miocardio y accidente cerebrovascular. El objetivo de este trabajo fue describirlas en los pacientes internados por COVID-19 y su evolución. Se realizó un estudio observacional unicéntrico prospectivo que comparó las características basales, factores de riesgo, tasa de eventos tromboembólicos, estadía y mortalidad hospitalaria entre los pacientes que se internaron en cuidados intensivos o sala general. Se incluyeron 1125 pacientes, 124 internados en unidad cuidados intensivos y 1001 internados en sala general de internación. La edad promedio fue de 46 ± 18 años, con 585 (52%) de sexo femenino. La tasa global de eventos tromboembólicos fue de 4.4%, siendo significativamente mayor en los pacientes de UCI (29% vs. 1.4%; p < 0.001) a pesar del elevado uso de heparina profiláctica (91.1% vs. 84.9%; p < 0.1), comparados con los internados en SGI. Los factores predictores independientes de desarrollo de eventos tromboembólicos fueron: la edad, el dímero D y la creatinina. La mortalidad global fue 4.3%, siendo significativamente mayor en los pacientes de cuidados intensivos sobre los de sala general de internación (29% vs. 1.3%; p < 0.001). Los pacientes que requieren internación por COVID-19 presentan elevada tasa de eventos tromboembólicos a pesar del uso de tromboprofilaxis con heparina, generando un impacto pronóstico negativo sobre la supervivencia de aquellos internados en cuidados intensivos.


Abstract Coronavirus disease-19 has emerged as a devastating global public health crisis. An increased frequency of arterial and venous thrombosis was observed in COVID-19 infection. The objective of this study was to describe the thromboembolic complications of patients hospitalized for COVID-19 and their evolution. A prospective single-center study was conducted that compared the characteristics, risk factors, thromboembolic event rate, hospital stay and mortal ity among patients admitted to intensive care or general ward. The mean age of population was 46 ± 18 years, and 52% were female. The global rate of thromboembolic events was 4.4%, significantly higher in intensive unit patients (29% vs 1.4%; p < 0.001) despite the high use of prophylactic heparin (91.1% vs. 84.9%; p < 0.1). The independent predictive factors for the development of thromboembolic events were: age, D-dimer and creatinine. Of the patients admitted to intensive care, 45.1% required mechanical ventilation. Overall mortality was 4.3%, significantly higher in intensive care patients than in the general hospital ward (29% vs. 1.3%; p < 0.0001). Pa tients requiring hospitalization due to infection secondary to COVID-19 have a high rate of thromboembolic events despite the use of thromboprophylaxis with heparin, generating a negative prognostic impact on the survival of patients admitted to intensive care.

10.
Säo Paulo med. j ; 140(1): 123-133, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1357464

ABSTRACT

ABSTRACT BACKGROUND: The intensity of the thromboprophylaxis needed as a potential factor for preventing inpatient mortality due to coronavirus disease-19 (COVID-19) remains unclear. OBJECTIVE: To explore the association between anticoagulation intensity and COVID-19 survival. DESIGN AND SETTING: Retrospective observational study in a tertiary-level hospital in Spain. METHODS: Low-molecular-weight heparin (LMWH) status was ascertained based on prescription at admission. To control for immortal time bias, anticoagulant use was analyzed as a time-dependent variable. RESULTS: 690 patients were included (median age, 72 years). LMWH was administered to 615 patients, starting from hospital admission (89.1%). 410 (66.7%) received prophylactic-dose LMWH; 120 (19.5%), therapeutic-dose LMWH; and another 85 (13.8%) who presented respiratory failure, high D-dimer levels (> 3 mg/l) and non-worsening of inflammation markers received prophylaxis of intermediate-dose LMWH. The overall inpatient-mortality rate was 38.5%. The anticoagulant nonuser group presented higher mortality risk than each of the following groups: any LMWH users (HR 2.1; 95% CI: 1.40-3.15); the prophylactic-dose heparin group (HR 2.39; 95% CI, 1.57-3.64); and the users of heparin dose according to biomarkers (HR 6.52; 95% CI, 2.95-14.41). 3.4% of the patients experienced major hemorrhage. 2.8% of the patients developed an episode of thromboembolism. CONCLUSIONS: This observational study showed that LMWH administered at the time of admission was associated with lower mortality among unselected adult COVID-19 inpatients. The magnitude of the benefit may have been greatest for the intermediate-dose subgroup. Randomized controlled trials to assess the benefit of heparin within different therapeutic regimes for COVID-19 patients are required.


Subject(s)
Humans , Adult , Aged , Venous Thromboembolism , COVID-19 , Heparin, Low-Molecular-Weight/therapeutic use , SARS-CoV-2 , Inpatients , Anticoagulants/therapeutic use
13.
J. Transcatheter Interv ; 3020220101. tab
Article in English, Portuguese | LILACS-Express | LILACS | ID: biblio-1399203

ABSTRACT

A embolia pulmonar, uma doença com risco de vida, é prevalente em todo o mundo, afetando grande porcentagem da população e representando uma das principais causas de morte cardiovascular. Para reduzir sua mortalidade e morbidade e melhorar os desfechos, é fundamental uma estratificação precoce do risco. Há uma ampla variação na gravidade de uma embolia pulmonar, desde leve até com risco de vida. Quando um paciente tem uma embolia pulmonar de alto risco e está em choque ou parada cardíaca, é razoável realizar trombólise sistêmica ou embolectomia de emergência, mas a anticoagulação isolada tem ótimos resultados na embolia pulmonar de baixo risco. Há várias estratégias para aproveitar os benefícios da trombólise e minimizar seus riscos, mas a experiência clínica com essas novas estratégias de intervenção é limitada. A equipe de resposta à embolia pulmonar, composta de cardiologista intervencionista, radiologista intervencionista, cirurgião cardíaco, radiologista especializado em imagem cardíaca e intensivista, pode ajudar a determinar o tipo de intervenção em um determinado paciente. Este artigo traz um esboço das terapias intervencionistas endovasculares atuais e seu contexto.


This life-threatening condition, known as pulmonary embolism, is prevalent throughout the world, affecting a large percentage of population and representing one of the leading causes of cardiovascular death. To reduce mortality and morbidity and improve outcomes, early risk stratification is critical. There is a wide range in the severity of a pulmonary embolism, from mild to life-threatening. When a patient has a high-risk pulmonary embolism and is in shock or cardiac arrest, emergency systemic thrombolysis or embolectomy is reasonable, but anticoagulation alone has great results in low-risk pulmonary embolism. Multiple strategies exist to capture the benefits of thrombolysis while minimizing its risks, but clinical experience with such novel intervention strategies is limited. The pulmonary embolism response team comprises interventional cardiologist, interventional radiologist, cardiac surgeon, cardiac radiologist, and critical care specialist, can help determine the type of intervention in a given patient. This article provides an outline of current endovascular interventional therapies and their context.

14.
Article in English | WPRIM | ID: wpr-934785

ABSTRACT

@#Introduction: Pelvic and acetabulum fractures are commonly caused by high impact injuries, increasing the risk of patients developing thromboembolic diseases such as deep vein thrombosis (DVT) and pulmonary embolism (PE). Therefore, this study was performed to determine the incidence of lower extremity DVT in patients with pelvic and acetabulum fractures and the importance of preoperative screening with Doppler ultrasound prior to surgical intervention. Materials and methods: This retrospective study involved 78 patients with pelvic and acetabulum fractures requiring surgical intervention from January 2015 until December 2019. Patients who underwent surgical interventions were screened pre-operatively with Doppler ultrasound to detect lower limb DVT and later compared with the incidence of lower limb DVT post-operatively. Descriptive statistical analysis was performed using IBM SPSS Statistics Version 24. Results: The participants of this study consisted of 30.8% females and 69.2% males. Pre-operative screening with Doppler ultrasound showed that three patients (3.8%) were diagnosed with lower limb DVT, whereas one of them (1.3%) was symptomatic and diagnosed with PE. Postoperatively, one patient developed DVT, and one patient developed PE. Both patients were negative for DVT preoperatively. Conclusion: The incidence of DVT in patients with pelvic and acetabulum fractures requiring operative intervention was significant despite the initiation of mechanical and pharmacological thromboprophylaxis upon admission. Despite the low incidence of DVT in our study, it has a high impact on patients’ morbidity and mortality; thus, preoperative screening is important for early detection and the subsequent reduction of the risk of developing PE. The compulsory use of Doppler ultrasound of bilateral lower limbs as a part of pre-operative screening is highly recommended because it is cost-effective, efficient and readily available in most tertiary hospitals nationwide.

15.
Article in Chinese | WPRIM | ID: wpr-933743

ABSTRACT

Objective:To investigate the risk factors of long-term mortality in patients with acute pulmonary embolism (APE) and to explore the predictive value of echocardiography.Methods:A total of 109 APE patients admitted in First Hospital of Shanxi Medical University between December 2010 and November 2014 were enrolled in this study. APE was diagnosed by computed tomography pulmonary angiography (CTPA) or ventilation-perfusion pulmonary scintigraphy. Transthoracic echocardiography (TTE) parameters and clinical parameters within 48 h of onset were collected. All the patients were treated with standard anticoagulation, thrombolysis, or thrombectomy. Regular follow-up was carried out, with the average follow-up period of (7.20±1.04) years. The patients were divided into survival group and fatal group according to their follow-up results. The echocardiographic parameters and primary biochemical laboratory parameters within 48 h after onset were compared between the survival group and the fatal group by t test or χ 2 test. Cox regression analysis was conducted to analyze the influencing factors of long-term prognosis of patients with APE. Survival analysis was performed in patients with echocardiographic assessment of right ventricular (RV) enlargement and/or dysfunction and without RV enlargement and/or dysfunction by Kaplan-Meier method, and the survival curves were plotted. The comparison between the two groups was performed by log-rank test. Results:The average follow-up period was (7.20±1.04) years. Fourteen patients were lost in the follow-up, and 95 patients were included in the final analysis, among whom 58 survived and 37 died with a fatality rate of 39.0%. Cox regression analysis showed that age ( HR=2.32, 95% CI:1.31-4.13, P=0.004), malignancy ( HR=6.49, 95% CI:2.32-18.14, P<0.001), right atrial (RA)/left atrial (LA) area ratio ( HR=2.01, 95% CI:1.16-3.48, P=0.013), RV enlargement and/or dysfunction ( HR=5.90, 95% CI: 1.45-23.94, P=0.013), Charlson comorbidity index (CCI) score ( HR=1.75, 95% CI: 1.04-2.96, P=0.035), low oxygen saturation ( HR=1.70, 95% CI:1.14-2.53, P=0.009) were independent risk factors associated with long-term mortality in patients with APE. Kaplan Meier survival curve analysis showed that the cumulative survival rates of patients with RV enlargement and/or dysfunction at 1, 3, 5 and 7 years were 92.8%, 66.7%, 59.4% and 52.2% respectively, and those without RV enlargement and/or dysfunction were 96.2%, 92.3%, 84.6% and 84.6%,respectively (log rank test, P=0.006). Conclusions:Patients with APE have high long-term mortality. Early echocardiographic RV enlargement and/or dysfunction, RA/LA area ratio, age, malignant tumor, CCI score and low oxygen saturation are independent risk factors related to long-term mortality in patients with APE. Ultrasound evaluation of patients with RV enlargement and/or dysfunction has a certain value in predicting long-term mortality in patients with pulmonary embolism.

16.
Chinese Journal of Radiology ; (12): 556-562, 2022.
Article in Chinese | WPRIM | ID: wpr-932539

ABSTRACT

Objective:To evaluate the effectiveness and safety of the home-made umbrella-shaped Octoparms inferior vena cava filter in the prevention of pulmonary embolism.Methods:A multicenter, randomized, positive parallel controlled, non-inferiority clinical trial was conducted in ten hospitals in China from October 2017 to March 2019. A total of 188 subjects were enrolled according to the same inclusion and exclusion criteria in different institutes. The 188 subjects were randomly divided into the trial group or the control group according to 1∶1 by the central randomization system, with 94 cases in each group. Octoparms inferior vena cava filter was used in the trial group, and the Celect inferior vena cava filter in the control group. The primary effective index was clinical success rate,including the clinical success rate of filter placement and filter retrieval. The secondary index included the rate of manual success of the delivery sheath system,incidence of pulmonary embolism(within 6 months), incidence of filter fracture,migration (>20 mm),tilt(>15°) on insertion/retrieval,and the situation of inferior vena cava flow(within 6 months). Safety evaluation included the incidence of filter related complications and device-related adverse events immediately after surgery and during follow-up.Results:The success rate of implantation was 100% in 188 subjects. Filter retrieval was performed in 87 cases (92.55%) in the trial group and 91 cases (96.81%) in the control group. The clinical success rate of the trial group was 97.87%(92/94) and that of the control group 98.94%(93/94). There was no significant difference between the two groups (χ 2=0.77, P=0.380). The success rate of delivery sheath system was 96.81%(91/94) and 98.94%(93/94) in the trail group and the control group,respectively. There was no significant difference between the two groups( P=0.621). There was 1 case (1.22%) of new asymptomatic pulmonary embolism in the trial group after filter placement and 2 cases (2.44%) in the control group. There was no significant difference between the two groups ( P>0.05). No filter fracture or migration (>20 mm) occurred in either group. The tilting of filter (>15°) was found in 1 case (1.06%) in the test group and 1 case (1.06%) in the control group when the filter was placed. The tilting of filter (>15°) was found in 0 case in the test group and 2 cases (2.44%) in the control group when the filter was retrieved. There was no significant difference between the two groups ( P>0.05). Inferior vena cava thrombosis before filter retrieval was found in 5 cases (5.75%) in trial group and 3 cases (3.30%) in control group. There was no significant difference between the two groups ( P=0.489). There were no immediate serious complications during filter placement/removal in either group. No filter obstruction,migration,deformation,penetration and occlusion of inferior vena cava. The incidence of device-related adverse events was low in both group. There was no significant difference between the two groups ( P>0.05). Conclusion:The home-made umbrella-shaped Octoparms inferior vena cava filter is effective and safe in preventing pulmonary embolism, and is not worse than Celect filter.

17.
Article in Chinese | WPRIM | ID: wpr-931133

ABSTRACT

Objective:To investigate the therapeutic effect of rivaroxaban combined with ateplase on patients with acute pulmonary embolism and its influence on inflammatory factors and coagulation function.Methods:One hundred and two patients with acute pulmonary embolism admitted to the First People′s Hospital of Linping District from March 2016 to March 2020 were divided into observation group (51 cases) and control group (51 cases) by random number table.Methods:The control group was treated with ateplase, and the observation group was treated with rivaroxaban on the basis of the control group. The course of treatment in both groups was 10 d. The effective and the changes of arterial partial pressure of oxygen (PaO 2), partial pressure of carbon dioxide in artery (PaCO 2), heart rate(HR), inflammatory factors and coagulation index were compared before and after treatment between the two groups. Results:The total effective rate after treatment in the observation group was higher than that in the control group: 90.20%(46/51) vs. 68.63%(35/51), the difference was statistically significant ( χ2 = 7.256, P<0.05). The level of PaO 2 after treatment in the observation group was higher than that in the control group, the levels of PaCO 2 and HR after treatment in the observation group were lower than those in the control group: (82.91 ± 4.35) mmHg (1 mmHg = 0.133 kPa) vs. (73.35 ± 2.97) mmHg, (34.21 ± 2.89) mmHg vs. (39.98 ± 3.25) mmHg, (76.83 ± 3.76) beats/min vs. (84.20 ± 3.15) beats/min, the differences were statistically significant ( t = 12.96, 9.48, 9.17, P<0.05). The levels of interleukin (IL)- 1β, IL-6 and tumor necrosis factor-α after treatment in the observation group were lower than those in the control group: (0.62 ± 0.20) μg/L vs. (1.08 ± 0.23) μg/L, (15.42 ± 2.53) μg/L vs.(20.93 ± 2.78) μg/L, (0.49 ± 0.16) μg/L vs. (0.78 ± 0.12) μg/L, the differences were statistically significant ( t = 10.78, 10.47, 10.36, P<0.05). The levels of fibrinogen, D-Dimer after treatment in the observation group were lower than those in the control group: (2.78 ± 0.61) g/L vs. (3.53 ± 0.54) g/L, (1.18 ± 0.23) mg/L vs. (1.69 ± 0.28) mg/L; but the levels of prothrombin time, activate part plasma prothrombin time after treatment in the observation group were longer than those in the control group: (15.85 ± 1.48) s vs. (13.04 ± 1.27) s, (40.79 ± 2.34) s vs. (37.46 ± 2.98)s, the differences were statistically significant ( t = 6.58, 10.05, 10.29, 6.28, P<0.05). Conclusions:Rivaroxaban combined with ateplase is effective in the treatment of acute pulmonary embolism, and it can reduce inflammatory reaction and improve coagulation function.

18.
Article in Chinese | WPRIM | ID: wpr-930823

ABSTRACT

There are more and more cases of pulmonary embolism in children, most of whom have etiology or risk factors, and the clinical features are not specific.At present, there is a lack of large samples of clinical researches in children.The methods of evaluation, diagnosis and treatment of pulmonary embolism in children mostly refer to adult experience and standards.No unified standards are applied to children.This review analyzed the risks factors, diagnosis, evaluation and treatments of pulmonary embolism in children, in order to help clinicians judge and treat their patients.

19.
Article in Japanese | WPRIM | ID: wpr-924530

ABSTRACT

A 57-year-old man presented with a one-month history of dyspnea. Computed tomography revealed a pulmonary embolism, and echocardiography revealed multiple linear floating thrombi in the right atrium. An urgent surgical thrombectomy was performed, and most of the thrombi in the right atrium and bilateral pulmonary arteries were removed under cardiopulmonary bypass. The thrombi in the right atrium adhered to the linear Chiari networks. The patient was treated with rivaroxaban uneventfully and subsequently discharged on postoperative day 26. Herein, we report a case of right atrial thrombi and pulmonary embolism likely augmented by the Chiari network, which was successfully treated with surgical thrombectomy.

20.
Article in English | WPRIM | ID: wpr-923829

ABSTRACT

@#BACKGROUND: Acute pulmonary embolism (APE) with cardiac arrest (CA) is characterized by high mortality in emergency due to pulmonary arterial hypertension (PAH). This study aims to determine whether early pulmonary artery remodeling occurs in PAH caused by massive APE with CA and the protective effects of increasing angiotensin-converting enzyme (ACE) 2-angiotensin (Ang) (1-7)-Mas receptor axis and ACE-Ang II-Ang II type 1 receptor (AT1) axis (ACE2/ACE axes) ratio on pulmonary artery lesion after return of spontaneous circulation (ROSC). METHODS: To establish a porcine massive APE with CA model, autologous thrombus was injected into the external jugular vein until mean arterial pressure dropped below 30 mmHg (1 mmHg=0.133 kPa). Cardiopulmonary resuscitation and thrombolysis were delivered to regain spontaneous circulation. Pigs were divided into four groups of five pigs each: control group, APE-CA group, ROSC-saline group, and ROSC-captopril group, to examine the endothelial pathological changes and expression of ACE2/ACE axes in pulmonary artery with or without captopril. RESULTS: Histological analysis of samples from the APE-CA and ROSC-saline groups showed that pulmonary arterioles were almost completely occluded by accumulated endothelial cells. Western blotting analysis revealed a decrease in the pulmonary arterial ACE2/ACE axes ratio and increases in angiopoietin-2/angiopoietin-1 ratio and expression of vascular endothelial growth factor (VEGF) in the APE-CA group compared with the control group. Captopril significantly suppressed the activation of angiopoietin-2/angiopoietin-1 and VEGF in plexiform lesions formed by proliferative endothelial cells after ROSC. Captopril also alleviated endothelial cell apoptosis by increasing the B-cell lymphoma-2 (Bcl-2)/Bcl-2-associated X (Bax) ratio and decreasing cleaved caspase-3 expression. CONCLUSION: Increasing the ACE2/ACE axes ratio may ameliorate pulmonary arterial remodeling by inhibiting the apoptosis and proliferation of endothelial cells after ROSC induced by APE.

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