[HSF] Pulmonary embolism-RV dysfunction

[prasannasimha]

The hemodynamically threatening clot was the one which happened now 
isn't it ? Also mechanical thrombolysis does mash up and break the older 
clots. Those that are broken up are now susceptible to thrombolysis.

Prasanna

rwmfglycar at aol.com wrote:
> 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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