Evaluation of the CT imaging findings in the diagnosis of pulmonary hypertension due to chronic thromboembolism

ConclusionThe results of the this study confirm the important role of MDCTA in the evaluation of vascular, cardiac and parenchymal findings in the patients with CTEPH and identifying patients that would most benefit from surgical treatment by visualization of the segmental and subsegmental branches of the pulmonary arteries.
Source: The Clinical Respiratory Journal - Category: Respiratory Medicine Authors: Tags: ORIGINAL ARTICLE Source Type: research

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We describe the case of a 55-year-old patient with a history of pulmonary embolism who presented in shock with ST-elevation on his electrocardiogram. He was triaged to the catheterization laboratory where he suffered a cardiac arrest. A pulmonary embolism was diagnosed angiographically, the thrombus was aspirated, and he received systemic thrombolysis. The combination of clot debulking and systemic thrombolysis acted synergistically to improve his right ventricular function by resolving his pulmonary hypertension. Although it is associated with a higher bleeding risk, the combination of clot aspiration with a thrombolytic ...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
Abstract Antiphospholipid syndrome (APS) is an acquired thrombophilia with an uncertain role in the development of chronic thromboembolic pulmonary hypertension (CTEPH). We aimed to assess the association of APS with the clinical phenotype of CTEPH. We retrospectively reviewed data of CTEPH patients referred to our center. Clinical, angiographic, and hemodynamic data were available for all patients. APS was diagnosed in the presence of one or more positive antiphospholipid (aPL) tests confirmed more than 12 weeks apart. Data were compared between APS-positive and APS-negative patients. From May 2013 to December 20...
Source: Thrombosis and Haemostasis - Category: Hematology Authors: Tags: Thromb Haemost Source Type: research
A 81-year-old male patient with chronic obstructive lung disease, decompensated severe calcified aortic stenosis, moderately to severely reduced biventricular systolic function, and atrial fibrillation with secondary pulmonary hypertension was referred to our institution. He was treated with diuretics, oral anticoagulants followed by low dose beta blocker. After cardiac recompensation coronary artery disease was excluded by coronary angiogram. Computed tomography (CT) angiography was performed prior to transcatheter aortic valve replacement (TAVR). Unexpectedly, CT (Panel C) and transthoracic echocardiography without contr...
Source: European Heart Journal - Category: Cardiology Source Type: research
We describe the case of a 55-year old patient with a history of pulmonary embolism who presented in shock with ST-elevation on his electrocardiogram. He was triaged to the catheterization laboratory where he arrested. A pulmonary embolism was diagnosed angiographically, the thrombus was aspirated, and he received systemic thrombolysis. The combination of clot debulking and systemic thrombolysis acted synergistically to improve his right ventricular function by resolving his pulmonary hypertension. Although it is associated with a higher bleeding risk, the combination of clot aspiration with thrombolytic in the treatment of...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
Publication date: Available online 13 March 2019Source: The Annals of Thoracic SurgeryAuthor(s): Tomohito Kanzaki, Satoshi Numata, Sachiko Yamazaki, Hitoshi YakuAbstractA 75-year-old woman was referred to our hospital for dyspnea and edema of the lower limbs. Computed tomography angiography revealed a dilated left coronary artery from the left main trunk to the left circumflex branch and a dilated fistula originating from the left circumflex branch and draining into the persistent left superior vena cava. Physical examination revealed pulmonary hypertension and congestive heart failure. We performed closure of the fistula ...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
Abstract BACKGROUND: Thrombolytic therapy is usually reserved for patients with clinically serious or massive pulmonary embolism (PE). Evidence suggests that thrombolytic agents may dissolve blood clots more rapidly than heparin and may reduce the death rate associated with PE. However, there are still concerns about the possible risk of adverse effects of thrombolytic therapy, such as major or minor haemorrhage. This is the third update of the Cochrane review first published in 2006. OBJECTIVES: To assess the effects of thrombolytic therapy for acute pulmonary embolism. SEARCH METHODS: The Cochrane Vasc...
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
​BY FREDDIE IRIZARRY-DELGADO; VAROON KAKAIYA; &AHMED RAZIUDDIN, MDAn 86-year-old African-American woman was brought to the ED by her daughter after two days of nutritional neglect, abdominal pain, and altered mental status. Her daughter said her mother felt lightheaded, appeared dehydrated, and vomited nonbilious watery fluid once. The patient had a history of diabetes mellitus type 2, DVT/PE, dementia, and early signs of parkinsonism.Her vital signs were remarkable only for tachypnea (24 bpm). Her troponin I was markedly elevated at 1.7 ng/mL. A D-dimer was ordered because of her history of unprovoked DVT/PE, and it...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
Rationale: Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe complication of antiphospholipid syndrome (APS). Once diagnosed, the recommendation for the treatment of CTEPH is long-term anticoagulation and pulmonary thromboendarterectomy (PTE). However, cardiac surgeons apply PTE cautiously for these patients, as there is an increased risk of perioperative complications. Here, we present the curative case of a patient with severe APS-associated CTEPH treated with PTE. Patient concerns: A 29-year-old man presented with chest pain, decreased exercise capacity, dyspnoea, and haemoptysis. Diagnoses: He w...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Authors: Minatsuki S, Hatano M, Kiyosue A, Saito A, Maki H, Takimoto E, Komuro I Abstract Riociguat, a soluble guanylate cyclase stimulator, induces pulmonary artery dilatation through blood flow and is effective in treating chronic thromboembolic pulmonary hypertension (CTEPH). There are two types of vasculopathies in CTEPH based upon its location, in other words, proximal or distal to the thrombus-medicated obstruction. Distal vasculopathy is characterized by intrapulmonary shunts due to diminished blood flow. While other therapeutic interventions for CTEPH including pulmonary endarterectomy and balloon pulmonary...
Source: International Heart Journal - Category: Cardiology Tags: Int Heart J Source Type: research
Chronic thromboembolic pulmonary hypertension (CTEPH) is a distinct type of pulmonary hypertensive disease, characterized by incomplete or abnormal resolution of acute pulmonary embolism such that residual emboli become organized and fibrotic. CTEPH can occur in patients without a prior history of venous thromboembolism, and is diagnosed based on precapillary pulmonary hypertension on right heart catheterization with evidence of chronic emboli on ventilation/perfusion scan, chest imaging, or pulmonary angiogram. Pulmonary endarterectomy (PEA) is often curative, and results in improved survival. In patients for whom PEA is ...
Source: Heart Failure Clinics - Category: Cardiology Authors: Source Type: research
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