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At least 1,621 records · Page 90Linked to original sources
PubMed2004

Atrial fibrillation and thrombosis: immunohistochemical differences between in situ and embolized thrombi.

BACKGROUND/OBJECTIVE: Thromboembolism secondary to atrial fibrillation accounts for approximately one-fourth of all strokes. Although considerable resources have been targeted to pharmacologic prophylaxis, neither the cellular nor the biochemical composition of atrial thrombi is known. Quantitative immunohistochemistry was undertaken to define the composition of atrial thrombi and to explore morphological differences between atrial appendage thrombi and those that embolize. PATIENTS/METHODS: Serial sections of thrombi obtained during valve replacement surgery or embolectomy from 22 patients with atrial fibrillation were stained with antibodies against fibrin, integrin beta3, or tissue factor and analyzed with NIH-image. RESULTS: Thrombi showed distinct regions staining for either fibrin or platelets and on average, the fibrin-rich regions predominated (P < 0.0001). The platelet content of embolized thrombi was nearly twice that of atrial thrombi (P = 0.02). Non-staining amorphous material comprised nearly half of atrial thrombi in situ, but was rare in embolized thrombi (P < 0.001). Tissue factor colocalized to areas rich in platelets and granulocytes. CONCLUSIONS: The abundance of fibrin relative to platelets underscores the enhanced efficacy of warfarin prophylaxis in clinical trials. The finding of tissue factor localized to platelet-leukocyte clusters suggests its blood-borne origin. Compositional differences between in situ and embolized thrombi suggest directions for investigating propensity for embolization.

Aged↗
PubMed1991

Complications of intraaortic balloon counterpulsation insertion in patients receiving thrombolytic therapy for acute myocardial infarction.

This study retrospectively examines 38 patients who presented with acute myocardial infarction requiring intraaortic balloon pump counterpulsation. Two groups of patients were identified. Group I consisted of patients with acute myocardial infarction treated with intraaortic balloon pump without thrombolytic therapy. Group II consisted of patients treated with intraaortic balloon pump after receiving intravenous thrombolytic therapy. These groups were compared and contrasted with regard to previously identified complications associated with intraaortic balloon pump counterpulsation including loss of limb and mortality. The need for surgery, embolectomy, and drainage of hematoma were also evaluated. The need for surgery in group II (11%) and in both groups combined (7%) is lower than is generally reported in literature (range 11.6% to 34%). In addition, no patients experienced a loss of limb and no patients in the study had severe life-threatening iatrogenic morbidity or mortality. While mortality was not an end point in this study, it was noted that there was an increased survival rate in group II patients with 61% surviving until the time of hospital discharge. Also, eight out of 14 patients in group II who underwent intraaortic balloon pump counterpulsation for cardiogenic shock survived until the time of discharge. This represents a 57% survival rate for patients presenting with cardiogenic shock. We conclude that intraaortic balloon pumps can be inserted safely following thrombolytic therapy in a community hospital.

Adult↗
PubMed1991

Successful treatment of massive pulmonary embolism by combined mechanical and thrombolytic therapy.

In two patients with massive pulmonary embolism and cardiogenic shock requiring mechanical ventilation and prolonged external cardiac massage, occluded pulmonary arteries were recanalized by primary mechanical fragmentation of thrombi using a percutaneously inserted catheter followed by fibrinolytic therapy. The hemodynamic and respiratory parameters rapidly and greatly improved. Pulmonary angiography before discharge revealed normal results in both patients. No central neurological abnormalities were detected. It is concluded that patients with cardiogenic shock due to massive pulmonary embolism may benefit from immediate mechanical thrombus fragmentation followed by fibrinolysis when thrombolysis or surgical embolectomy are strictly contraindicated or not available.

Adult↗
PubMedDate not supplied

Minimally invasive valve surgery.

BACKGROUND: Cardiac surgery has been the last area of clinical surgery to adopt and embrace minimally invasive surgical techniques. Since the onset of arterial embolectomy in 1965, arthroscopic knee surgery performed in 1975 and laparoscopic cholecystectomy in 1985, huge advances in videoscopic, thorascopic and small incision surgery has taken place in all specialties which now allow change in the traditional approaches to cardiac valve surgery. In 1996, the Brigham and Women's Hospital, along with other units, began minimally invasive cardiac valve surgery for patients who had isolated valve pathology without coronary disease. Our experience now totals 689 patients, including 353 minimally invasive mitral valve repair/replacements and 336 minimally invasive aortic valve replacements, including root replacement and reoperations. METHODS: This new operative approach involves smaller incisions, the mandatory use of transesophageal echocardiogram for the monitoring of operation quality and air removal, newer perfusion techniques and some modifications in the standard valve repair/replacement techniques. With this blending of TEE, better perfusion techniques and new exposure, the safety and quality of valve operations by these techniques have been excellent. RESULTS AND CONCLUSION: The operative mortality is equal to (AVR) or less than (MVP) conventional open sternotomy cases and there is a shorter length of stay in the ICU and post-ICU, leading to a lower cost than conventional procedures. There are also less blood transfusions, atrial fibrillation and posthospital rehabilitation requirements, and patients have indicated that there is a faster return to normality over the conventional operative approaches. This brief report summarizes our experience from July, 1996 to January 2001.

Heart Valve Diseases↗
PubMedDate not supplied

Recurrent pulmonary artery sarcoma.

Pulmonary artery sarcomas are a diagnostic and therapeutic challenge. Most patients are initially thought to have pulmonary emboli, and during embolectomy, a sarcoma is found. Given the significant morbidity and mortality of cardiac sarcomas, an aggressive strategy for resection is indicated, as this leads to benefits in disease-free and overall survival. Imaging tests and clinical signs and symptoms may assist in accurate preoperative determination of pulmonary artery sarcoma. We present an interesting case of a patient with pulmonary artery sarcoma who underwent successful re-resection, along with a brief discussion regarding preoperative imaging and the surgical resection of these tumors.

Aged↗
PubMed1981

Repair in arterial tissue.

Both reendothelialized and non-reendothelialized surfaces of rabbit aortas, subjected to an embolectomy catheter lesion, were sectioned parallel to the neointimal surface. Microfilament bundles within endothelial cells were associated with extracellular anchoring filaments, lying parallel to the long axis in sections from reendothelialized areas. Proteoglycans coated the surface of anchoring filaments and joined together all the elements of connective tissue in the subendothelial space. In non-reendothelialized areas covered by smooth muscle cells, anchoring filaments were less prominent, almost no proteolglycans were visible, and connective tissue components were randomly mixed. We propose an influence of endothelial cells on the orientation and composition of the subendothelial connective tissue.

Animals↗
PubMed1969

Portable ethylene oxide sterilization chamber.

A portable ethylene oxide sterilization chamber was designed, constructed, and tested for use in the sterilization of embolectomy catheters. The unit can accommodate catheters up to 40 inches (101.6 cm) in length and can be operated for less than 4 cents per cycle. A constant concentration of 500 mg of ethylene oxide per liter of space and holding periods of 4 and 6 hr at 43 and 22 C, respectively, were adequate when tested with B. subtilis spores. The estimated cost of construction was $165.00. If temperature control is unnecessary, the cost is approximately $80.00.

Bacillus subtilis↗
PubMed1968

Streptokinase therapy in acute major pulmonary embolism: effectiveness and problems.

Eighteen patients with major pulmonary embolism were treated with streptokinase infused by a catheter or given intravenously. Fourteen showed clinical improvement and 12 out of 16 patients investigated showed definite angiographic improvement after 24 to 48 hours of treatment with streptokinase. The angiographic improvement following streptokinase contrasted with the lack of this in three patients after 24 hours of heparin treatment.Resolution following streptokinase therapy was most noticeable in patients treated shortly after a single embolic episode, and was least marked in those with recurrent embolism complicated by associated cardiac or pulmonary disease. Of the four patients who failed to improve, two died and two had pulmonary embolectomy and survived.The results suggest that streptokinase therapy is practicable provided that adequate laboratory control is available, and that it hastens early resolution in acute major pulmonary embolism.

Acute Disease↗
PubMed2001

Diagnostic value of transoesophageal echocardiography in suspected haemodynamically significant pulmonary embolism.

OBJECTIVE: To assess the value of transoesophageal echocardiography (TOE) for diagnosing suspected haemodynamically significant pulmonary embolism and signs of right ventricular overload at standard echocardiography. METHODS: 113 consecutive patients (58 male; 55 female), mean (SD) age 53.6 (13.3) years, in whom there was clinical suspicion of pulmonary embolism and right ventricular overload on transthoracic echocardiography, underwent TOE in addition to routine diagnostic procedures to identify pulmonary artery thrombi. RESULTS: TOE revealed thrombi in 32 of 51 patients who had suspected acute pulmonary embolism and in 31 of 62 with suspected chronic pulmonary embolism. In one patient a pulmonary angiosarcoma rather than chronic pulmonary embolism was found at surgery. The diagnosis of pulmonary embolism was confirmed in 77 patients by scintigraphy, spiral computed tomography, angiography, or necropsy (reference methods). While TOE failed to provide a diagnosis of pulmonary embolism in 15 of these 77 patients, no false positive findings were reported (sensitivity 80.5%, specificity 97.2%). In 11 and 26 cases, respectively, the thrombi were confined to the left or right pulmonary artery. Bilateral thrombi were found in 25 patients. Mobile thrombi were observed only in acute pulmonary embolism (in 19 of 32 patients). No complications of TOE were noted. CONCLUSIONS: TOE permits visualisation of pulmonary arterial thrombi, confirming the diagnosis in the majority of patients with pulmonary embolism and right ventricular overload. This may be useful for prompt decision making in patients with haemodynamic compromise considered for thrombolysis or embolectomy.

Echocardiography↗
PubMed1976

Pulmonary hydatid embolization. Report on 2 operated cases and review of published reports.

Two patients with pulmonary hydatid embolization are described and commented upon in the light of 43 similar published cases. The diagnosis was strongly suspected from the medical history and the chest x-ray films and supported by angiocardiography. The angiocardiographic features of this condition have not been described previously in detail. They include amputation and filling defects of pulmonary artery branches, which are typically located proximal to a rounded tumour-like opacity seen on the plain x-ray film. Both patients underwent successful embolectomy.

Adult↗
PubMed1977

Long-term prognosis of treated acute massive pulmonary embolism.

Seventy-two patients surviving initial treatment by pulmonary embolectomy, streptokinase, or heparin for acute massive pulmonary embolism have been reviewed 1 to 9 years later. Of these patients, 17 had additional cardiorespiratory disease. There were 12 late deaths (41% of those patients with, and 9% of those patients without additional cardiorespiratory disease). No death was due to chronic pulmonary hypertension, and none to certain recurrence of pulmonary embolism. The causes of death were malignant disease (6 patients), cardiopulmonary disease other than pulmonary embolism (4 patients), and 'sudden' (2 patients). Though venous interruption surgery was not used, and long-term anticoagulation rare, the incidence of possible or probable recurrent embolism was low (6%). There was no definite evidence of persistence or subsequent development of pulmonary hypertension after treatment in any patient. Resolution of embolism as judged by symptoms, signs, electrocardiogram, and chest x-ray examination was almost always complete. Some pulmonary arteriograms 1 to 6 months after initial treatment showed minor abnormalities, but others at a later date were normal. Perfusion lung scans carried out 1 to 8 years after initial treatment often showed minor abnormalities.

Adult↗
PubMed1981

Subacute massive pulmonary embolism.

Twenty-four patients with subacute massive pulmonary embolism were studied both during their initial illness and up to nine years after it. The most common mode of presentation was progressive dyspnoea over a two to 12 week period, which in some, but not all, patients was accompanied by pleuritic chest pain and haemoptysis. Physical signs at diagnosis usually suggested right heart strain and ventilation/perfusion mismatch and in the five patients with the highest pulmonary artery pressures the pulmonary component of the second sound was accentuated. The chest x-ray and electrocardiogram provided useful diagnostic information in most patients though occasionally they were normal. Early response to thrombolytic treatment was poor when compared with patients with acute pulmonary embolism but was occasionally dramatically successful, and heparin alone provided satisfactory treatment in the eight patients receiving it. Pulmonary embolectomy provided poor results and four of the five patients undergoing this form of treatment died. Nine patients died during the initial illness and in seven death was directly related to embolic disease. One patient died from neoplastic disease during follow-up. Though the prolonged illness, poor initial response to treatment, and absence of predisposing factors suggest that recurrent embolic disease and late pulmonary hypertension might occur three was no evidence of this during a follow-up period of one to nine years (median five years).

Adult↗
PubMed1985

Right atrial embolus. Echocardiographic features.

Although the value of echocardiography in detecting left heart thrombus is well recognised, right atrial thromboembolism has rarely been identified in life. In two patients with pulmonary embolism of varying severity cross sectional echocardiography identified a thrombus moving freely within the right atrium and clearly showed its string-like or even tubular structure. An embolectomy, based on the echocardiographic diagnosis, was undertaken successfully in one patient. The value of routine echocardiography in patients with suspected pulmonary embolism is yet to be confirmed.

Aged↗
PubMed1992

Right-sided endomyocardial fibrosis with recurrent pulmonary emboli leading to irreversible pulmonary hypertension.

A 26 year old Saudi man with features of both Loeffer's endocarditis and endomyocardial fibrosis presented with mild symptoms and pulmonary emboli. Echocardiographic examination showed obliteration of the right ventricular apex by an attached mass. The results of haemodynamic studies were somewhat abnormal and medical treatment was started. Despite anticoagulation with warfarin the patient's condition deteriorated rapidly over a four month period after a further episode of pulmonary embolism and the development of pulmonary hypertension. Two haemodynamic studies performed four months apart were typical of pulmonary hypertension and later right ventricular failure; they showed none of the characteristics of restriction. Pulmonary embolectomy was attempted but there was no cleavage plane between the organised thrombi and the endothelium of the pulmonary artery. The patient died of severe pulmonary hypertension and right ventricular failure several days after operation. Surgical intervention in the early stages of right-sided endomyocardial fibrosis might have prevented the development of pulmonary embolism and pulmonary hypertension.

Adult↗
PubMed1994

Pericardial effusion after cardiac surgery: incidence, site, size, and haemodynamic consequences.

OBJECTIVE: To evaluate the incidence, characteristics, and haemodynamic consequences of pericardial effusion after cardiac surgery. DESIGN: Clinical, echocardiographic, and Doppler evaluations before and 8 days after cardiac surgery; with echocardiographic and Doppler follow up of patients with moderate or large pericardial effusion after operation. SETTING: Patients undergoing cardiac surgery at a tertiary centre. PATIENTS: 803 consecutive patients who had coronary artery bypass grafting (430), valve replacement (330), and other types of surgery (43). 23 were excluded because of early reoperation. MAIN OUTCOME MEASURES: Size and site of pericardial effusion evaluated by cross sectional echocardiography and signs of cardiac tamponade detected by ultrasound (right atrial and ventricular diastolic collapse, left ventricular diastolic collapse, distension of the inferior vena cava), and Doppler echocardiography (inspiratory decrease of aortic and mitral flow velocities). RESULTS: Pericardial effusion was detected in 498 (64%) of 780 patients and was more often associated with coronary artery bypass grafting than with valve replacement or other types of surgery; it was small in 68.4%, moderate in 29.8%, and large in 1.6%. Loculated effusions (57.8%) were more frequent than diffuse ones (42.2%). The size and site of effusion were related to the type of surgery. None of the small pericardial effusions increased in size; the amount of fluid decreased within a month in most patients with moderate effusion and in a few (7 patients) developed into a large effusion and cardiac tamponade. 15 individuals (1.9%) had cardiac tamponade; this event was significantly more common after valve replacement (12 patients) than after coronary artery bypass grafting (2 patients) or other types of surgery (1 patient after pulmonary embolectomy). In patients with cardiac tamponade aortic and mitral flow velocities invariably decreased during inspiration; the echocardiographic signs were less reliable. CONCLUSIONS: Pericardial effusion after cardiac surgery is common and its size and site are related to the type of surgery. Cardiac tamponade is rare and is more common in patients receiving oral anticoagulants. Echo-Doppler imaging is useful for the evaluation of pericardial fluid accumulations after cardiac surgery. It can identify effusions that herald cardiac tamponade.

Adolescent↗
PubMed1979

The role of chemotherapy in the management of fungal endocaridits following homograft valve replacement.

Initial intensive combined chemotherapy, with late re-operation when indicated, appears to give better results than immediate excision of the infected valve. The combination chemotherapy used in this series was amphotericin B (up to 100 mg/patient/day) and flucytosine (up to 12 g/patient/day). Serious side effects attributed to this chemotherapy were extremely rare. Candida infections were the most common and the Aspergillus infections were uniformly fatal. Embolectomies and excisions of large mycotic aneurysms were generally successful. Re-operation for late valve malfunction was common and yielded satisfactory results.

Amphotericin B↗
PubMed1987

Treatment of pulmonary embolism.

Most clinically important pulmonary emboli are associated with thrombosis of the proximal deep veins of the leg. Anticoagulant therapy is highly successful in reducing death and recurrence from pulmonary embolism and is the treatment of choice in the majority of these patients. Thrombolytic therapy is usually reserved for selected patients with clinically serious or massive pulmonary embolism. Vena caval interruption is limited to patients who have an absolute contraindication to anticoagulant therapy or who develop recurrent pulmonary embolism despite adequate anticoagulant therapy. Pulmonary embolectomy has a high mortality and should therefore be restricted to the most desperate cases.

Heparin↗
PubMed1977

The technology of balloon catheters in interventional angiography.

Balloon catheters with expansion capabilities from 1 mm to 6 cm have been developed. They feature torque control and can be selectively positioned within vessels as easily as the ordinary diagnostic angiographic catheters. The balloons can be utilized for hemorrhage control, conventional embolectomy, operative angiography, vena cava occlusion, and purposeful vascular thrombosis or dearterialization. In the event of unsuccessful control, the balloon can be readily deflated and removed within minutes.

Angiography↗