Reoperative pulmonary thromboendarterectomy

Mo, Makoto; Kapelanski, David P.; Mitruka, Surindra N.; Auger, William R.; Fedullo, Peter F.; Channick, Richard N.; Kerr, Kim M.; Archibald, Carol; Jamieson, Stuart W.

doi:10.1016/s0003-4975(99)01043-7

Cited by 74 publications

(40 citation statements)

References 17 publications

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“…Despite being empirical and analogous to other cardiac procedures, in which a second operation carries an increased mortality risk, no such increase was observed in the previously cited case series study. (3) A satisfactory post-operative evolution of our patient corroborates this observation.…”

Section: Discussionsupporting

confidence: 86%

“…However, the patients presented pronounced improvement of symptoms during the long-term follow-up treatment. (3) Therefore, reoperative thromboendarterectomy is preferred over lung transplantation or the inexorable evolution to right heart failure and death. Despite being empirical and analogous to other cardiac procedures, in which a second operation carries an increased mortality risk, no such increase was observed in the previously cited case series study.…”

Section: Discussionmentioning

confidence: 99%

“…(1,2) Recurrence of CTEPH after the first surgical treatment is rare, seen in 1.5% of the patients evaluated in the only case series study of such patients in the international literature. (3) However, reoperative thromboendarterectomy in patients presenting recurrence of CTEPH has not been reported in the national literature, its safety and effectiveness therefore remaining unclear.…”

Section: Introductionmentioning

confidence: 99%

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Reoperação de tromboendarterectomia pulmonar em recidiva de tromboembolismo pulmonar crônico hipertensivo

et al. 2009

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Here, we report the case of a patient presenting CTEPH recurrence five years after the first pulmonary thromboendarterectomy and requiring reoperative thromboendarterectomy for the resolution of the symptoms. Case reportA 28-year-old female patient presented with progressive dyspnea on exertion and chest pain for two months. Se had been submitted to pulmonary thromboendarterectomy five years prior, thereafter receiving warfarin, which had been discontinued one year prior. An electro- IntroductionThromboendarterectomy has been established as the treatment of choice in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH), providing, in the majority of cases, a consistent, definitive alternative for treating patients with this disease, with satisfactory shortand long-term results.(1,2) Recurrence of CTEPH after the first surgical treatment is rare, seen in 1.5% of the patients evaluated in the only case series study of such patients in the international literature. However, reoperative thromboendarterectomy in patients presenting recurrence of CTEPH has not been reported in the national literature, its safety and effectiveness therefore remaining unclear.Repeat pulmonary thromboendarterectomy after recurrence of chronic thromboembolic pulmonary hypertension* AbstractPulmonary thromboendarterectomy has been established as the standard method for the treatment of chronic thromboembolic pulmonary hypertension, with excellent results. However, repeat pulmonary thromboendarterectomy due to recurrence of pulmonary embolism has never been reported in the Brazilian literature. Its safety and effectiveness remain obscure. We report the case of a patient presenting recurrence of chronic thromboembolic pulmonary hypertension five years after the first pulmonary thromboendarterectomy and requiring a second operation for resolution of the symptoms.Keywords: Hypertension, pulmonary; Pulmonary embolism; Endarterectomy/methods. ResumoA cirurgia de tromboendarterectomia tem se estabelecido como método padrão de tratamento do tromboembolismo pulmonar crônico hipertensivo, com excelentes resultados. Entretanto, a reoperação na recidiva do embolismo pulmonar não tem relato na literatura nacional, permanecendo obscuras a sua segurança e efetividade. Relatamos o caso de uma paciente com recorrência de tromboembolismo pulmonar crônico hipertensivo ocorrido cinco anos após a primeira cirurgia de tromboendarterectomia pulmonar, e que necessitou de reoperação para resolução dos sintomas.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reoperação de tromboendarterectomia pulmonar em recidiva de tromboembolismo pulmonar crônico hipertensivo

et al. 2009

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“…Die Ursachen können vielfältig sein. Zum einen entstehen bei 2,5-7% der Patienten nach einer akuten Lungenembolie auch bei adäquater Behandlung Rezidivembolien [32]. Zum anderen können Appositionsthrombosen im Bereich (teil)thrombosierter Pulmonalgefäße [28] oder fehlende Autolyse des primären Thromboembolus charakteristische, aber sehr variable Veränderungen der zentralen und peripheren Pulmonalarterien mit chronischer Obstruktion und Okklusion herbeiführen [21].…”

Section: äTiologieunclassified

“…Aus eigener Erfahrung, korrelierend mit der Literatur [32], werden sie fast ausschließlich nach einer unzureichenden Primäroperation notwendig. Sicherlich kann dann bei Persistenz oder Progredienz des pulmonalen Hochdrucks eine Rezidivoperation in Betracht gezogen werden, sie bleibt aber ausgewählten Patienten vorbehalten.…”

Section: Ergebnisseunclassified

Chirurgie der chronischen pulmonalen Druckerhöhung

Iversen

Felderhoff

2005

Herz

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Bilateral pulmonary thromboendarterectomy has been recognized as the first-choice therapeutic option for patients with chronic thromboembolic pulmonary hypertension. With careful patient selection, meticulous surgical technique and careful postoperative management the surgical procedure has proven potentially curative for these often severely incapacitated patients in whom prognosis is otherwise poor. By means of pulmonary angiography and multislice CT correct diagnosis is established and the crucial question of operability determined.In the presence of significant exertional dyspnea and/or elevation of pulmonary vascular resistance surgery is indicated when the thromboembolic obstructions are determined accessible to surgical removal. Suboptimal surgical results may be obtained in patients with solely peripheral location of lesions, i. e., beginning at the bronchopulmonary segmental arteries, and correct patient selection becomes crucial especially in advanced stages of disease of very high pulmonary vascular resistance and presence of right heart failure.The surgical techniques are standardized with use of median sternotomy with cardiopulmonary bypass, deep hypothermia and periods of circulatory arrest and consist of complete dissection of the intimal layer of the pulmonary branches containing the thromboembolic lesions as a true endarterectomy technique.The reported operative mortality for pulmonary thromboendarterectomy differs in the literature between 4.5% and 23.5% and probably reflects not only the various experiences with this patient group but most likely also the disparate policies in patient selection. The authors' experience comprises 250 surgically treated patients with an operative mortality of 14.4%. The immediate hemodynamic and functional improvement of patients following successful thromboendarterectomy is excellent with further improvement during the first year. Pulmonary hypertension recurs over time in a few patients because of embolism, thrombosis or progression of reactive vasculopathy. However, the functional improvement and decrease of right ventricular afterload are persistent in the vast majority.Given the poor results of lung transplantation, this is not an alternative, and patients with chronic thromboembolic pulmonary hypertension should undergo thromboendarterectomy, preferably in the most early stage of their disease.

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Increasing Hypoxemia and Dyspnea in Mild Chronic Obstructive Pulmonary Disease

Medarov

Chaudhry

Myint

2017

JAMA

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A man with a 3-year history of chronic obstructive pulmonary disease presented with increasing dyspnea on exertion, requiring increasing flow rates of oxygen. He was a former smoker with a 50-pack-year history. He had been diagnosed with stage I low-grade prostate cancer several years previously.Lung examination showed no wheezing. Cardiac examination showed a prominent pulmonary component (P 2 ) of the second heart sound. Noncontrast computed tomography of the chest was unremarkable.An echocardiogram revealed dilated right atrium and ventricle. Spirometry showed mild airway obstruction. Duplex ultrasound showed a nonocclusive thrombus in the left femoral and popliteal veins. Catheterization of the right side of the heart showed a pulmonary arterial pressure of 79/32 mm Hg (mean, 48 mm Hg) with a normal pulmonary capillary wedge pressure. A ventilation-perfusion (V/Q) scan was obtained (Figure, panel A), followed by pulmonary angiography (Figure, panel B).

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Reoperative pulmonary thromboendarterectomy

Cited by 74 publications

References 17 publications

Reoperação de tromboendarterectomia pulmonar em recidiva de tromboembolismo pulmonar crônico hipertensivo

Reoperação de tromboendarterectomia pulmonar em recidiva de tromboembolismo pulmonar crônico hipertensivo

Chirurgie der chronischen pulmonalen Druckerhöhung

Increasing Hypoxemia and Dyspnea in Mild Chronic Obstructive Pulmonary Disease

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