PubMed · 2507021
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N Naqvi, S Mushahwar. 1989-08-12. Acute right ventricular infarction.. https://doi.org/10.1136/bmj.299.6696.459-b
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PURPOSE OF REVIEW: Pulmonary artery rupture is probably the most devastating complication associated with the use of the pulmonary artery catheter. This rare but disastrous situation requires a clear intervention plan. RECENT FINDINGS: The initial presentation of pulmonary artery ruptures may be as obvious as a massive pulmonary hemorrhage or as subtle as a cough associated with minimal hemoptysis, or it may even be totally asymptomatic. A patient presenting any clinical manifestation of pulmonary artery rupture may develop a pulmonary artery false aneurysm, which is the accumulation of blood in an aneurismal sac compressed by lung parenchyma. This condition requires intervention because delayed hemorrhage may occur and recurrence can be massive and fatal. Following an initial episode of suspected pulmonary artery rupture, the patient should undergo immediate radiological investigation. If a diagnosis of pulmonary artery false aneurysm is confirmed, selective angiographic embolization helps reduce morbidity and mortality. SUMMARY: The incidence of pulmonary artery ruptures is probably underestimated because many hemoptysis episodes or radiological infiltrations associated with pulmonary artery catheter use are not investigated. Also, the natural evolution of the pulmonary artery false aneurysm is unknown. The incidence of spontaneous healing, bleeding recurrence or asymptomatic persistence is unknown following formation of a pulmonary artery false aneurysm.
When pulmonary hypertension (HPT) is suspected invasive diagnosis provides final diagnosis, establishes the most important parameters for making a prognosis and identifies resulting abnormalities of the right and left ventricles. Cardiac catheterization gives data on cardiac function and thus additional information on the limits of physical capacity and prognostic assessment. Invasive diagnosis thus plays a key role, but clearly is not part of primary diagnosis, which in addition to clinical examination emphasizes Doppler echocardiography as a valid screening method. Noninvasive examinations are preferred for follow-up.
The German Network for Systemic Scleroderma (Deutsches Netzwerk Für Systemische Sklerodermie [DNSS]) has as its aim to improve and standardize the diagnosis and treatment of this rare disease. 14.6 % of patients in the DNSS register have been shown to have pulmonary hypertension (PHT). Comparable international data range from 12 % to 26.7 %. The DNSS recommends annual echocardiography for patients with scleroderma and right-heart catheterization if the systolic pulmonary arterial pressure is higher than 35 mmHg. Aggressive immunosuppressive treatment--in the first instance with cyclophosphamide--should be given only if there is also progressive fibrosis. Drugs that lower the level of PHT also have a favourable effect on other signs of scleroderma.