Baltazares LME, Rueda VP, Reyes LE, Serna SHI, Reveles ZL, Rodríguez CH

Language: Spanish
References: 9
Page: 192-197
PDF size: 75.39 Kb.

ABSTRACT

Pulmonary embolism is a global public health problem with estimated annual incidence of 100,000 cases ion France, 65,000 in England and Wales, 630,000 in the United States and 60,000 new cases per year in Italy. Mortality of untreated cases can be up to 30% and with adequate treatment of 2-8%. Chronic thromboembolic pulmonary arterial hypertension occurs in 0.1 to 0.5% of patients who survive to the embolic event, and is the result of main pulmonary artery obstruction due to the presence of pulmonary embolia. Obstruction of the pulmonary vascular bed contributes to the development of pulmonary arterial hypertension, which determines diverse degrees of right ventricular dysfunction and modifies patient survival expectancy. Chronic thromboembolic pulmonary arterial hypertension is potentially corrigible by pulmonary thromboendaterectomy with extracorporeal circulation, deep hypothermia at 16°C and retrograde cerebral perfusion. The present article reports a case of chronic pulmonary thromboembolia with 70% obstruction of the pulmonary vascular bed and right ventricle dysfunction, subjected to bilateral pulmonary thromboendarterectomy. Visible improvements in hemodynamic, respiratory and functional state parameters were observed. These variables increase life quality and survival expectancy.

REFERENCES

1. Sadosty AT, Boie ET, Stead LG. Pulmonary embolism. Emerg Med Clin N Am 2003;21:363-384.

2. Douketis JD, Kearon C, Bates S, Duku EK, Ginsberg JS. Risk of fatal pulmonary embolism in patient with treated venous thromboembolism. JAMA 1998;27:458-462.

3. Dartevelle P, Fadel E, Mussot S, Chapelier A, Hervé P, Perrot M, et al. Chronic thromboembolic pulmonary hypertension. Eur Respir J 2004;23:637-648.

4. Kroegel C, Reissig A. Principles mechanisms underlying venous thromboembolism: Epidemioloy, risk factors, patophysiology and pathogenesis. Respiration 2003;70:7-30.

5. Fedullo PF, Auger WR, Kerr KM, Rubin LJ. Chronic thromboembolic pulmonary hypertension. N Engl J Med 2001;345:1465-1472.

6. Wood KE. Major pulmonary embolism. Chest 2002;121:877-905.

7. Task Force on Pulmonary Embolism, European Society Cardiology. Guidelines on diagnosis and management of acute pulmonary Embolism. Eur Heart J 2000;21:1301-1335.

8. Archibald CJ, Auger WR, Fedullo PF, Channick RN, Kerr KM, Jamieson SW, et al. Long-term outcome after pulmonary thromboendarterectomy. Am J Respir Crit Care Med 1999;160:523-528.

9. Thistlethwaite PA, Auger WR, Madani MM, Pradhan S, Kapelanski DP, Jamieson SW. Pulmonary thromboendarterectomy combined with other cardiac operations: Indications, surgical approach, and outcome. Ann Thorac Surg 2001;72:13-19.