Review of echocardiographically diagnosed right heart entrapment of pulmonary emboli-in-transit with emphasis on management |
| |
| Authors: | Z Farfel M Shechter Z Vered S Rath D Goor J Gafni |
| |
| Affiliation: | 1. Department of Medicine, the Heart Institute, Sheba Medical Center at Tel Hashomer Tel Hashomer, Israel;2. Department of Cardiac Surgery, the Heart Institute, Sheba Medical Center at Tel Hashomer Tel Hashomer, Israel;3. the Heller Institute of Medical Research, Sheba Medical Center at Tel Hashomer Tel Aviv, Israel;4. Sackler School of Medicine, Tel Aviv University Tel Aviv, Israel;1. Department of Neurology, Division of Neurocritical Care and Emergency Neurology, Yale University School of Medicine, P.O. Box 208018, 15 York Street, LLCI Building, 10th floor, New Haven, CT, 06520, USA;2. Department of Neurology, UF Health Shands Hospital, University of Florida College of Medicine, PO Box 100236, Gainesville, FL 32610, USA;3. Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA;4. Department of Neurology, Boston University School of Medicine, 75 Newton Street, Boston, MA 02118, USA;5. Department of Neurology, Division of Neurocritical Care and Emergency Neurology, Yale University School of Medicine, 15 York Street, LLCI 810c, Box 208018, New Haven, CT 06510, USA;1. Frederik Meijer Heart and Vascular Institute, Spectrum Health, 100 Michigan Street Northeast, Grand Rapids, MI 49503, USA;2. Department of Emergency Medicine, Michigan State University College of Human Medicine, 15 Michigan Street Northeast, Suite 735, Grand Rapids, MI 49503, USA |
| |
| Abstract: | 2DE permits detection of thromboemboli transiently entrapped in the right heart chambers while en route to the pulmonary arteries. Review of the 49 cases recorded to date reveals that the supple elongated clot produces a 2DE picture--a mass of changing configuration and striking mobility--that is highly characteristic. Since emboli that become entrapped are large, when managed by medical measures alone they have an attendant mortality rate of 50%, usually soon after 2DE diagnosis, upon completion of pulmonary embolization. Death occurred in 8 of 16 patients treated with anticoagulants, thrombolytic agents, or antiaggregants and in 6 of 13 who received supportive measures only. Of 20 patients referred for surgery (cardiotomy and, in 17, pulmonary embolectomy), only three died, two of them failures of preceding anticoagulant treatment. These data indicate that thromboemboli entrapped in the right heart chambers are best handled as a surgical emergency. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
