Pulmonale Thrombendarteriektomie

Abstract

Chronic thromboembolic pulmonary hypertension with concomitant right heart failure may develop as a sequela of acute pulmonary embolism with organization instead of thrombolysis of intravascular clots. Medical therapy aims at prevention of recurrent embolism by anticoagulation and vascular remodelling using vasodilator therapy. Lung transplantation or combined heart-lung transplantation is associated with unsatisfactory long-term results and comorbidity and therefore remains justified only in selected patients. Pulmonary thromboendarterectomy allows specific treatment of intravascular obstruction. This closed endarterectomy of the pulmonary arteries requires deep hypothermic circulatory arrest and can be performed with a perioperative mortality of less than 10%. The procedure significantly decreases pulmonary vascular resistance and often normalizes pulmonary hemodynamics and gas exchange. Postoperatively the patients' clinical condition improves and the majority have normal exercise capacity and activity.

Microvascular disease in chronic thromboembolic pulmonary hypertension: a role for pulmonary veins and systemic vasculature

“…Pulmonary endarterectomy (PEA) has replaced lung transplantation and is today the only curative treatment for patients with CTEPH [7,8]. However, only selected patients are eligible for PEA, depending on surgical accessibility of thromboembolic residues and underlying comorbidities [9].…”

A metonímia segundo os gramáticos e rétores latinos

“…Segundo Lausberg, na implicação de fenômeno e símbolo (signum) sociais, o fundamento para a denominação concreta de um fenômeno social é dado pelo seu símbolo instrumental. 68 Metonímias desta espécie são mencionadas por Quintiliano: 'armorum' scientiam habere (ser conhecedor de "armas"); 69 e também por Cícero: togam pro pace, arma ac tela pro bello (toga em referência à paz, arma e lança à guerra). 70 Na poesia, observamos este uso no verso inicial da eneida: Arma uirumque cano (Eu canto as armas e o varão).…”