AW: [HSF] Pulmonary embolism-RV dysfunction

[Dr. Roberto Battellini]

Do not think in 2 months mortality, think in years...

Our experience is with 57 patients and 30% mortality for all risks. You can
see it in : ctsnet.org/journals/other Journals/The Thoracic and
Cardiovascular surgeon/Bossert et al.
Thoracic and cardiovascular Surgeon is the German Magazine for Heart
Surgery.
Roberto

-----Ursprüngliche Nachricht-----
Von: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von yadav del
Gesendet: Freitag, 3. August 2007 05:24
An: OpenHeart-L at lists.hsforum.com
Betreff: Re: [HSF] Pulmonary embolism-RV dysfunction

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 ?
>
> 
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