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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A new caval filter of helico-spiral geometry (Helix-Filter) was implanted in 13 patients for the prevention of pulmonary embolism (PE). The indications for implantation were: recurrent PE despite adequate anticoagulation (5 cases) or contraindication to anticoagulation (3 cases), incomplete local therapeutic fibrinolysis after severe paracentral PE (2 cases), and prophylaxis in high risk patients (3 cases). Implantation was effected by the saphenous/femoral vein approach in 12 patients, and via the right atrial appendage during open heart surgery in one instance. There were no intraoperative technical problems and in no case was the filter misplaced. During the follow-up period (mean 14.8 months, maximum 28 months) no filter-related complications were encountered. One patient with an exceptionally enlarged vena cava, due to abnormal renal vein inflow, had a fatal recurrent PE despite high dosage heparinization. One patient with an event-free follow-up died 12 months after filter placement from unrelated diseases. The remaining 11 patients are free of symptoms with no recurrent PE, no deterioration of venous circulation or presence of caval thrombosis. Emboli trapped at the filter were documented in 2 patients; spontaneous resolution occurred in one case. Experimental and early clinical results indicate that the hemodynamically optimal design of the Helix-Filter permits controlled and uniform luminal filtering with high patency. As such, it represents an alternative and highly promising solution to the problem of "mechanical" prevention of pulmonary embolism in selected patients.
Thorac Cardiovasc Surg 1986 Jun
PMID:Experience with the helix cava filter. 242 34

The results of treatment of pulmonary embolism with heparin (n = 34), streptokinase (n = 28) or embolectomy (n = 25) are presented. The treatment groups represented different degrees of embolization with acute embolic scores (possible maximum: 20, mean +/- SD): 5 +/- 4, 9 +/- 3 and 13 +/- 3, respectively (p less than 0.0001). The post-treatment embolic score (mean +/- SD) for patients with acute massive central emboli (score greater than or equal to 9) was: 6 +/- 4 (n = 7) and 3 +/- 2 (n = 15) in the streptokinase and embolectomy groups, respectively, (p less than 0.01). The hospital mortality was 6% (n = 2), 21% (n = 6) and 20% (n = 5) in the heparin, streptokinase and embolectomy groups, respectively (p less than 0.05). The 5-year cumulative survival (+/- SE) was 68% +/- 10, 64% +/- 10 and 80% +/- 8, respectively (p: NS). The relative survival (hospital and late deaths, observed/expected) stratified according to acute embolic score showed the best results in the embolectomy group. Systolic pulmonary artery pressure greater than 60 mmHg was found in cases with a duration of symptoms greater than 7 days and/or with greater than or equal to 25 anamnestic recurrent embolic episodes before diagnosis, indicative of a gradual increase in pulmonary artery pressure and of partly organized non-lyseable emboli. Embolectomy carried a low risk of complications (8% with cerebral reduction). Streptokinase treatment was associated with serious complications (18% with cerebral reduction/fatal hemorrhage). Pulmonary embolectomy should be recommended in all cases with emboli in the main branches of the pulmonary artery.(ABSTRACT TRUNCATED AT 250 WORDS)
Thorac Cardiovasc Surg 1986 Aug
PMID:Treatment of pulmonary embolism with full-dose heparin, streptokinase or embolectomy--results and indications. 242 92

During 1949-1964 only 22% of our patients (n = 6807) undergoing cardiac surgery were older than 40 years. Up to 1970 no patients older than 60 years underwent open-heart surgery in our institution. Between 1970 and 1978 an open-heart procedure was performed in 174 patients older than 60 years (4.5%). The hospital mortality was 18.3%. During the following years the operative indication for aged patients became more liberal, and the operative risk decreased distinctly. Already in 1983 the percentage of aged people rose to 24.1% of our extracorporeal circulation group (n = 1111). In a retrospective study (1979 to 1985) a total of 6855 heart procedures using ECC were evaluated. In total 196 patients (2.9%) were 70 years and older. Valvular replacement was performed in 95 cases. (AVR n = 67, MVR n = 13, DVR n = 15) resulting in a hospital mortality of 10.9% (n = 10). Revascularisation for coronary heart disease including resection of ventricular aneurysms was necessary in 64 patients with an early mortality rate of 3.1% (n = 2). The highest risk group consisted of combined coronary and valvular procedures (n = 33) with a mortality rate of 12.1% (n = 4). There was one case each of ASD II, HOCM, left atrial myxoma, and massive pulmonary embolism with cardiogenic shock: only the latter patient died, from cerebral hypoxia postoperatively. Thus the hospital mortality in this age group (n = 196) was 9.1% (n = 17).(ABSTRACT TRUNCATED AT 250 WORDS)
Thorac Cardiovasc Surg 1987 Jun
PMID:Coronary and valvular surgery in elderly patients (greater than 70 years). 244 32

Intraoperative angioscopy was performed in three patients who underwent pulmonary embolectomy for massive pulmonary embolism. Angioscopy followed conventional techniques such as extracting the clot by a gallstone forceps, using a Fogarty catheter in the pulmonary tree or squeezing of the lungs. The rationale for angioscopy was to assess the result of these usual "blind" techniques. In two patients residual thrombus was detected and removed under direct visual control. Our initial experience suggests that intraoperative angioscopy appears to be useful in the detection of residual thrombus material, especially in the asanguinous, arrested heart. The small size of the angioscope allows easily access to the secondary, and up to the tertiary pulmonary branches. Clots can be visualized and extracted under direct visual control.
J Cardiovasc Surg (Torino)
PMID:Intraoperative fiberoptic angioscopy to evaluate the completeness of pulmonary embolectomy. 267 56

Inferior vena cava occlusion following caval interruption (clip, plication, umbrella) for recurrent pulmonary embolism is not uncommon. Patients who are severely disabled by lower extremity venous hypertension following caval occlusion should be considered for caval bypass procedure with concomitant Greenfield filter placement. This report details such a case and outlines the management, including coagulopathy workup.
J Cardiovasc Surg (Torino)
PMID:Vein to caval bypass and insertion of suprarenal cava filter for caval occlusion. 280 13

One hundred and sixteen patients with proximal deep venous thrombosis (DVT) confirmed venographically had perfusion and ventilation lung scans performed 48 hours after admission to assess the incidence of asymptomatic pulmonary embolism (PE). Sixty-six patients had normal lung scans, 29 had high-probability defects suggestive of PE, and 21 had indeterminate-probability of PE. Chest X-ray, electrocardiogram and arterial blood gases were of no value in assessing the lung scan results. Six out of 29 patients with a baseline lung scan of high probability of PE experienced acute signs and/or symptoms suggestive of pulmonary embolism while on heparin therapy. A repeated scan this time did not disclose new perfusion defects in any patients. In the absence of a baseline study, these scans may be interpreted as demonstrating pulmonary embolism on treatment and lead to unnecessary caval interruption procedures for failed heparin therapy.
J Cardiovasc Surg (Torino)
PMID:Asymptomatic pulmonary embolism in patients with deep vein thrombosis. Is it useful to take a lung scan to rule out this condition? 292 65

Calcified thrombus of the inferior vena cava (IVC) in children is an entity usually not associated with significant complications. The possibility of pulmonary embolism from the soft thrombus, however, has been suggested but never reported. We give an account of a child with transposition of the great vessels who suffered embolization from a calcified thrombus in the IVC that entered the systemic circulation.
Cardiovasc Intervent Radiol 1986
PMID:Calcified thrombus of the inferior vena cava in transposition of the great vessels. 308 36

This case reports a 23-year-old female who experienced a massive bilateral pulmonary embolism. The source of thrombi was found to be in a large saccular aneurysm of the right ovarian vein. The pulmonary emboli were treated by local infusion of streptokinase. The patient was cured after removal of the aneurysm by surgery.
Cardiovasc Intervent Radiol 1987
PMID:Aneurysm of the right ovarian vein--an unusual cause of pulmonary embolism. 310 19

Insertion of a vena cava filter is a therapeutic alternative for patients in whom anticoagulation is not effective or appropriate. The Greenfield filter is associated with a 95% long-term patency rate and a low incidence of mortality or recurrent embolization. Although insertion can be done through the femoral or jugular route, the right femoral vein is the easiest, most direct approach to the inferior vena cava (IVC). Pulmonary arteriography remains the "gold standard" for establishing the diagnosis of pulmonary embolism.
Cardiovasc Intervent Radiol 1988
PMID:Vena cava filter insertion and angiographic diagnosis of pulmonary embolism. 313 Oct 4

The fibrinolytic system is activated by the conversion of plasminogen to plasmin by mediators such as tissue extract, plasma factor XII, or the exogenous activators urokinase (UK) and streptokinase (SK). The foreign protein composition of SK is responsible for the allergic response observed in some patients following administration. Clinical and investigational evidence has also shown a higher incidence of hemorrhagic complications with SK compared with UK. In general, thrombolytic therapy is a safe, effective way to resolve thrombotic obstruction in patients with such problems as acute pulmonary embolism, acute myocardial infarction, or occluded intravascular lines.
Cardiovasc Intervent Radiol 1988
PMID:Fundamentals of fibrinolytic therapy. 313 Oct 5


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