Pulmonary embolectomy re-evaluated.

D B Clarke

Home/Archive/PubMed

PubMed · 7247257

Pulmonary embolectomy re-evaluated.

D B Clarke

View original source ↗Export metadata ↓

Abstract

Forty-two patients who had sustained massive pulmonary embolism were treated by emergency pulmonary embolectomy using normothermic venous inflow occlusion circulatory arrest. Of 26 patients who had not had cardiac arrest before surgery 25 survived the operation, but 7 later died from various causes. Only 1 of 16 patients who had sustained cardiac arrest survived. In all, 19 patients (45.2%) left hospital alive. This simple and widely applicable technique has enabled an emergency pulmonary embolectomy service to be offered to all the hospitals in a metropolitan area.

Explore related subjects

Cardiopulmonary Bypass Emergencies Humans Methods Pulmonary Embolism Streptokinase Urokinase-Type Plasminogen Activator Journal Article

Keep this discovery

Explore connections, maps & timelines

BibTeX RIS

D B Clarke. 1981. Pulmonary embolectomy re-evaluated.. https://pubmed.ncbi.nlm.nih.gov/7247257/

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2007

Invited commentary.

Explore the source record for details and available documents.

Cardiopulmonary Bypass↗

PubMed2007

Continuous SvO2 measurement in infants undergoing congenital heart surgery--first clinical experiences with a new fiberoptic probe.

BACKGROUND: SvO2-guided therapy, using fiberoptic oximetric catheters can help to improve the outcome after complex congenital heart surgery especially in infants undergoing the Stage 1-Norwood-Procedure. So far, fiberoptic catheters have to be placed transthoracically by the surgeon into the vena cava or the pulmonary artery putting the infant at an additional risk of bleeding at the time of catheter removal. METHODS: We used a new percutaneously applicable fiberoptic probe for continuous monitoring of central venous saturation in three infants undergoing modifications of the Stage 1-Norwood-Procedure (reconstruction of the aortic arch), two in combination with a bidirectional cavopulmonary connection (Glenn shunt), the third with reconstruction of the pulmonary arteries (biventricular repair). The approved clinical monitoring system consisted of a small (2 F) fiberoptic probe and a bed-side-monitor. The probe was inserted via the routine central venous access for such a case. RESULTS: Continuous SvO2 measurement is feasible in infants using the CeVOX system in combination with routine central venous access, and the advantages of continuous monitoring are discussed. CONCLUSIONS: We believe that compared with transthoracically inserted oximetric catheter, the presented percutaneous technique avoids additional risks at the time of catheter removal (i.e. bleeding) and has become part of our standard management.

Cardiopulmonary Bypass↗

PubMed2006

An alternative pathway for fibrinolysis is activated in patients who have undergone cardiopulmonary bypass surgery and major abdominal surgery.

INTRODUCTION: We conducted this prospective study in order to investigate the hypotheses that an alternative pathway for fibrinolysis is activated in patients who have undergone cardiopulmonary bypass (CPB) surgery and major abdominal surgery and that the levels of fibrin degradation products digested by polymorphonuclear neutrophil elastase (elastase-XDP) and the D-dimer increase in the patients' plasma. MATERIALS AND METHODS: We studied a total of 77 patients who were scheduled to undergo either CPB surgery (36 patients) or major abdominal surgery (41 patients) and then measured the elastase-XDP and D-dimer levels at several time points both during and after the surgeries. The CPB surgery was divided into surgery for aortic dissection (AD) and cardiac surgery. The major abdominal surgery consists of hepatic resection and esophagectomy. RESULTS: The elastase-XDP and D-dimer levels significantly increased in the patients who underwent both CPB surgery and major abdominal surgery. The elastase-XDP levels in AD surgery showed highest values at the end of the CPB, while the levels in the other surgeries reached their peak on the day after the surgery. Statistical difference was seen in the levels of elastase-XDP among the three subgroups undergoing a hepatic resection. While we found significant correlations between the levels of elastase-XDP and D-dimer in patients undergoing CPB surgery and a subsegmentectomy of a cirrhotic liver, the correlation coefficients were markedly low in comparison to those of the other surgeries. CONCLUSIONS: Our findings demonstrated that the elastase-mediated pathway of fibrinolysis is activated to varying degrees depending on the surgery performed. Variations in the correlation coefficients between the levels of elastase-XDP and D-dimer may suggest that elastase-mediated fibrinolysis play a different role from the physiological fibrinolysis mediated by plasmin.

Cardiopulmonary Bypass↗