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DOI: 10.1055/s-0032-1331286
Pulmonary Embolism in Deceivingly Stable Patients with High Thrombus Load—When Is Stable Really Safe?
Publication History
07 February 2012
21 May 2012
Publication Date:
20 February 2013 (online)
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Abstract
The definitive treatment of hemodynamically stable patients with pulmonary embolism and echocardiographically proven moderate to severe right ventricular dysfunction is unclear. We discuss the cases of a 45-year-old woman and a 62-year-old man that fulfilled the above criteria, but had a high risk for adverse events. Although both patients were treated according to current guidelines, one underwent successful surgical embolectomy the same day and the other was resuscitated a few days later. Surgery is an alternative for carefully selected patients with mild right ventricular dysfunction, but a high risk for adverse events that would otherwise be treated the same way as low- to moderate-risk patients.
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References
- 1 Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999; 353 (9162) 1386-1389
- 2 Jaff MR, McMurtry MS, Archer SL , et al; American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; American Heart Association Council on Peripheral Vascular Disease; American Heart Association Council on Arteriosclerosis, Thrombosis and Vascular Biology. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation 2011; 123 (16) 1788-1830
- 3 Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob GE, Comerota AJ. American College of Chest Physicians. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 (6, Suppl) 454S-545S
- 4 Torbicki A, Perrier A, Konstantinides S , et al; ESC Committee for Practice Guidelines (CPG). Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 2008; 29 (18) 2276-2315
- 5 Kucher N, Rossi E, De Rosa M, Goldhaber SZ. Prognostic role of echocardiography among patients with acute pulmonary embolism and a systolic arterial pressure of 90 mm Hg or higher. Arch Intern Med 2005; 165 (15) 1777-1781
- 6 Jiménez D, Aujesky D, Moores L , et al. Combinations of prognostic tools for identification of high-risk normotensive patients with acute symptomatic pulmonary embolism. Thorax 2011; 66 (1) 75-81
- 7 Goldhaber SZ. Integration of catheter thrombectomy into our armamentarium to treat acute pulmonary embolism. Chest 1998; 114 (5) 1237-1238
- 8 Aklog L, Williams CS, Byrne JG, Goldhaber SZ. Acute pulmonary embolectomy: a contemporary approach. Circulation 2002; 105 (12) 1416-1419
- 9 Grifoni S, Olivotto I, Cecchini P , et al. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation 2000; 101 (24) 2817-2822
- 10 Matthews JC, McLaughlin V. Acute right ventricular failure in the setting of acute pulmonary embolism or chronic pulmonary hypertension: a detailed review of the pathophysiology, diagnosis, and management. Curr Cardiol Rev 2008; 4 (1) 49-59
- 11 Leacche M, Unic D, Goldhaber SZ , et al. Modern surgical treatment of massive pulmonary embolism: results in 47 consecutive patients after rapid diagnosis and aggressive surgical approach. J Thorac Cardiovasc Surg 2005; 129 (5) 1018-1023
- 12 Engelberger RP, Kucher N. Catheter-based reperfusion treatment of pulmonary embolism. Circulation 2011; 124 (19) 2139-2144
- 13 Hoeper MM, Granton J. Intensive care unit management of patients with severe pulmonary hypertension and right heart failure. Am J Respir Crit Care Med 2011; 184 (10) 1114-1124