[HSF] Pulmonary embolism-RV dysfunction

[Ani Anyanwu]

Prasanna
 
Can you provide data or experience to back this viewpoint that catheter based lysis is better?
 
My reading of the literature is that RV dysfunction is a risk factor for death and mandates immediate surgical removal. Consensus statements and writings also seem to promote surgery as the method of choice in this regard.
 
Ani



> Date: Fri, 3 Aug 2007 13:53:40 +0530> From: prasannasimha at gmail.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Pulmonary embolism-RV dysfunction> CC: > > Yesif there is recent major surgery then catheter directed mechanical lysis> would be better- allows the PA pressure to fall. Nature will do tis natural> thrombolysis. This is the way nonfatal PE's resolve. We are just allowing> nature to take its course by keeping the patient alive till then. We can> accelerate this with thrombolysis if the other factors are not detrimental.,> > On 8/3/07, yadav del <yadavluck at yahoo.com> wrote:> >> > An year back the particular plastic surgery unit lost a patient from> > bleeding at surgical site[Abdominoplasty and liposuction] after thrombolysis> > for PE.May be it would have made them not to take lightly the risk of> > bleeding from thrombolysis in the immediate post op period> >> > I think hard data is lacking even for thrombolysys for ry dysfunction> > criteria alone for advantage in terms of mortality. one of the studies> > showed no difference in 2 month mortality with or with out thrombolysis for> > this category of patients.> > One of the studies showed benefit in terms of end point of combined> > mortality and need for escalation of therapy[like adding inotropes].> >> > Regional throbolysis over few hours often leads to systemic lytic> > state with same risks of bleeding.> > We advised filter for this patient and plastic surgeons followed the> > advise of internists who felt they would advise it only in the circumstance> > of further progress in thrombosis inspite of anticoagulation.> > She had relative resistance to heparin [ptt 45 at 2200 units per hr> > heparin infusion and it responded to FFP.> >> > prasannasimha <prasannasimha at gmail.com> wrote:> > Catheter based mechanical lysis with a pigtail followed by thrombolysis> > can be done. If not then consideration for surgical embolectomy could be> > thought of. We have done quite a few catheter based lysis which gives a> > dramatic reduction in PA pressure and recovery of RV function.> > Prasanna> >> > yadav del wrote:> > >> > >> > > 25 yrs old female developed pulmonary embolism on 2 nd post op day after> > repair of incisional hernia. CT scan showed emboli at both hila .Only left> > lower lobe artery is spared from emboli. Duplex scan showed bilateral ilio-> > femoral dvt. She iss haemodynamically stable. Saturation 94% with out oxygen> > and 98% on 2litres oxygen. Echo showed RV dysfunction.> > >> > > Should she be offered pulmonary embolectomy in view of RV dysfunction ?> > >> > >> > > ---------------------------------> > > Moody friends. Drama queens. Your life? Nope! - their life, your story.> > > Play Sims Stories at Yahoo! Games.> > > _______________________________________________> > > OpenHeart-L mailing list> > >> > > Send postings to:> > > OpenHeart-L at lists.hsforum.com> > >> > > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > > http://mmp.cjp.com/mailman/listinfo/openheart-l> > >> > > All messages transmitted by the OpenHeart-L are subject to the policies> > and> > > disclaimers posted at:> > > http://www.hsforum.com/listdisclaim> > > -----------------------------------------> > >> > >> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L at lists.hsforum.com> >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > http://mmp.cjp.com/mailman/listinfo/openheart-l> >> > All messages transmitted by the OpenHeart-L are subject to the policies> > and> > disclaimers posted at:> > http://www.hsforum.com/listdisclaim> > -----------------------------------------> >> >> >> > ---------------------------------> > Pinpoint customers who are looking for what you sell.> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L at lists.hsforum.com> >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > http://mmp.cjp.com/mailman/listinfo/openheart-l> >> > All messages transmitted by the OpenHeart-L are subject to the policies> > and> > disclaimers posted at:> > http://www.hsforum.com/listdisclaim> > -----------------------------------------> >> > > > -- > Prasanna Simha M> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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