[HSF] Pulmonary embolism-RV dysfunction

[rwmfglycar at aol.com]

Prasanna,
If you examine removed pulmonary emboli some are fresh soft  red cell 
clots and some firm organised clots.  An experiment was done in dogs 
back in the 60's. The inf.  vena cava was temporarily tied in the upper 
and lower abdomen. The ties were released after 24 hours and after one 
week and the clots expressed up towards the heart. The 24 hour clots 
lysed spontaneously in a short time. The oneweek clots did not and of 
course were critically disabling.

Incidentally we participated in a randomised trial in the late 60's 
early 70's comparing heparin wth urokinase. These were angiographically 
proven but not immediately life threatenig cases. There was no 
difference.
Bob


-----Original Message-----
From: Prasanna Simha M <prasannasimha at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Fri, 3 Aug 2007 2:23 am
Subject: Re: [HSF] Pulmonary embolism-RV dysfunction






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 ?
> >
> >
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--
Prasanna Simha M
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