WJCS  Vol.3 No.6 , October 2013
Life-Threatening Pulmonary Embolism: A Multidisciplinary Approach to Diagnosis and Management
ABSTRACT
Current treatment of life threatening venous thrombo-embolism (VTE) has been based on general concepts dating to the early 1900s. In this manuscript a general overview of current diagnostic and therapeutic methods of VTE is presented along with the Emory University Affiliated Hospitals’ experience of the surgical treatment of life threatening VTE. We retrospectively analyzed the data of twenty-seven consecutive patients who underwent pulmonary embolectomy on cardiopulmonary bypass from January 1998 through April 2010. Our results showed successful outcomes after urgent or emergent surgical pulmonary embolectomy. It encourages the choice of an early and aggressive surgical approach for large pulmonary emboli in hemodynamically unstable patients.


Cite this paper
O. M. Lattouf, K. Leeper and H. Kelli, "Life-Threatening Pulmonary Embolism: A Multidisciplinary Approach to Diagnosis and Management," World Journal of Cardiovascular Surgery, Vol. 3 No. 6, 2013, pp. 190-196. doi: 10.4236/wjcs.2013.36038.
References
[1]   F. Trendelenburg, “Operative Management of Pulmonary Emboli,” Arch Klin Chir, Vol. 86, 1908, pp. 686-700.

[2]   M. Imielinski, et al., “Common Variants at Five New Loci Associated with Early-Onset Inflammatory Bowel Disease,” Nature Genetics, Vol. 41, No. 12, 2009, pp. 1335-1340. http://dx.doi.org/10.1038/ng.489

[3]   J. Gibbon, “Artificial Maintenance of Circulation during Experimental Occlusion of Pulmonary Artery,” Archives of Surgery, Vol. 34, No. 6, 1937, pp. 1105-1131.

[4]   E. H. Sharp, “Pulmonary Embolectomy: Successful Re-Moval of a Massive Pulmonary Embolus with the Support of Cardiopulmonary Bypass, Case Report,” Annals of Surgery, Vol. 156, No. 1, 1962, pp. 1-4. http://dx.doi.org/10.1097/00000658-196207000-00001

[5]   S. Z. Goldhaber, “Pulmonary Embolism,” Lancet, Vol. 363, No. 9417, 2004, pp. 1295-305. http://dx.doi.org/10.1016/S0140-6736(04)16004-2

[6]   W. Kasper, et al., “Management Strategies and Determi-Nants of Outcome in Acute Major Pulmonary Embolism: Results of a Multicenter Registry,” Journal of the American College of Cardiology, Vol. 30, No. 5, 1997, pp. 1165-1171. http://dx.doi.org/10.1016/S0735-1097(97)00319-7

[7]   S. Konstantinides, et al., “Heparin plus Alteplase Compared with Heparin Alone in Patients with Submassive Pulmonary Embolism,” The New England Journal of Medicine, Vol. 347, No. 15, 2002, pp. 1143-1150. http://dx.doi.org/10.1056/NEJMoa021274

[8]   I. Rubinstein, D. Murray and V. Hoffstein, “Fatal Pulmonary Emboli in Hospitalized Patients. An Autopsy Study,” Archives of Internal Medicine, Vol. 148, No. 6, 1988, pp. 1425-1426. http://dx.doi.org/10.1001/archinte.1988.00380060189033

[9]   J. E. Dalen and J. S. Alpert, “Natural History of Pulmonary Embolism,” Progress in Cardiovascular Diseases, Vol. 17, No. 4, 1975, pp. 259-270. http://dx.doi.org/10.1016/S0033-0620(75)80017-X

[10]   W. R. Bell and T. L. Simon, “Current Status of Pulmonary Thromboembolic Disease: Pathophysiology, Diagnosis, Prevention, and Treatment,” American Heart Journal, Vol. 103, No. 2, 1982, pp. 239-262. http://dx.doi.org/10.1016/0002-8703(82)90498-7

[11]   J. B. Dimick, et al., “Hospital Costs Associated with Surgical Complications: A Report from the Private-Sector National Surgical Quality Improvement Program,” Journal of the American College of Surgeons, Vol. 199, No. 4, 2004, pp. 531-537. http://dx.doi.org/10.1016/j.jamcollsurg.2004.05.276

[12]   A. M. Kaunitz, et al., “Causes of Maternal Mortality in the United States,” Obstetrics and Gynecology, Vol. 65, No. 5, 1985, pp. 605-612.

[13]   F. A. Anderson Jr., et al., “A Population-Based Perspective of the Hospital Incidence and Case-Fatality Rates of Deep Vein Thrombosis and Pulmonary Embolism. The Worcester DVT Study,” Archives of Internal Medicine, Vol. 151, No. 5, 1991, pp. 933-938. http://dx.doi.org/10.1001/archinte.1991.00400050081016

[14]   N. Kucher, et al., “Massive Pulmonary Embolism,” Circulation, Vol. 113, No. 4, 2006, pp. 577-582. http://dx.doi.org/10.1161/CIRCULATIONAHA.105.592592

[15]   V. Pengo, et al., “Incidence of Chronic Thromboembolic Pulmonary Hypertension after Pulmonary Embolism,” The New England Journal of Medicine, Vol. 350, No. 22, 2004, pp. 2257-2264. http://dx.doi.org/10.1056/NEJMoa032274

[16]   V. F. Tapson, “Acute Pulmonary Embolism,” The New England Journal of Medicine, Vol. 358, No. 10, 2008, pp. 1037-1052. http://dx.doi.org/10.1056/NEJMra072753

[17]   S. Z. Goldhaber and C. G. Elliott, “Acute Pulmonary Em-Bolism: Part I: Epidemiology, Pathophysiology, and Diagnosis,” Circulation, Vol. 108, No. 22, 2003, pp. 2726-2729. http://dx.doi.org/10.1161/01.CIR.0000097829.89204.0C

[18]   J. C. Lualdi and S. Z. Goldhaber, “Right Ventricular Dys-Function after Acute Pulmonary Embolism: Pathophysi-Ologic Factors, Detection, and Therapeutic Implications,” American Heart Journal, Vol. 130, No. 6, 1995, pp. 1276-1282. http://dx.doi.org/10.1016/0002-8703(95)90155-8

[19]   G. Piazza and S. Z. Goldhaber, “Acute Pulmonary Embolism: Part I: Epidemiology and Diagnosis,” Circulation, Vol. 114, No. 2, 2006, pp. e28-e32. http://dx.doi.org/10.1161/CIRCULATIONAHA.106.620872

[20]   U. J. Schoepf, et al., “Subsegmental Pulmonary Emboli: Improved Detection with Thin-Collimation Multi-Detector Row Spiral CT,” Radiology, Vol. 222, No. 2, 2002, pp. 483-490. http://dx.doi.org/10.1161/CIRCULATIONAHA.106.620872

[21]   U. J. Schoepf and P. Costello, “CT Angiography for Diagnosis of Pulmonary Embolism: State of the Art,” Radiology, Vol. 230, No. 2, 2004, pp. 329-337. http://dx.doi.org/10.1148/radiol.2302021489

[22]   P. D. Stein, F. Kayali and R. E. Olson, “Trends in the Use of Diagnostic Imaging in Patients Hospitalized with Acute Pulmonary Embolism,” The American Journal of Cardiology, Vol. 93, No. 10, 2004, pp. 1316-1317. http://dx.doi.org/10.1016/j.amjcard.2004.02.022

[23]   U. J. Schoepf, et al., “Right Ventricular Enlargement on Chest Computed Tomography: A Predictor of Early Death in Acute Pulmonary Embolism,” Circulation, Vol. 110, No. 20, 2004, pp. 3276-3280. http://dx.doi.org/10.1161/01.CIR.0000147612.59751.4C

[24]   G. Thabut, et al., “Thrombolytic Therapy of Pulmonary Embolism: A Meta-Analysis,” Journal of the American College of Cardiology, Vol. 40, No. 9, 2002, pp. 1660-1667. http://dx.doi.org/10.1016/S0735-1097(02)02381-1

[25]   F. S. Cross and A. Mowlem, “A Survey of the Current Status of Pulmonary Embolectomy for Massive Pulmonary Embolism,” Circulation, Vol. 35, Suppl. 4, 1967, pp. I86-I91.

[26]   P. Stulz, et al., “Decision Making in the Surgical Treatment of Massive Pulmonary Embolism,” European Journal of Cardio-Thoracic Surgery: Official Journal of the European Association for Cardio-Thoracic Surgery, Vol. 8, No. 4, 1994, pp. 188-193. http://dx.doi.org/10.1016/1010-7940(94)90113-9

[27]   K. Yalamanchili, et al., “Open Pulmonary Embolectomy for Treatment of Major Pulmonary Embolism,” The Annals of Thoracic Surgery, Vol. 77, No. 3, 2004, pp. 819-823. http://dx.doi.org/10.1016/j.athoracsur.2003.08.008

[28]   M. Leacche, et al., “Modern Surgical Treatment of Massive Pulmonary Embolism: Results in 47 Consecutive Patients after Rapid Diagnosis and Aggressive Surgical Approach,” The Journal of Thoracic and Cardiovascular Sugery, Vol. 129, No. 5, 2005, pp. 1018-1023. http://dx.doi.org/10.1016/j.jtcvs.2004.10.023

[29]   A. Digonnet, et al., “Acute Pulmonary Embolism: A Cur-Rent Surgical Approach,” Interactive Cardiovascular and Thoracic Surgery, Vol. 6, No. 1, 2007, pp. 27-29. http://dx.doi.org/10.1510/icvts.2006.141366

 
 
Top