Critical Canadian Health: Thromboendarterectomy

18 March, 2015 (13:27) | Critical Care | By: Health news

Eboendarterectomy, the flow through the pulmonary arterial bed increases and right and left ventricular functions return to normal values. The effects on patients were obvious within 2 weeks of surgery and further prove the beneficial immediate effect of thromboendarterectomy. Interestingly, most patients could have their parameters assessed by transthoracic, rather than transesophageal, echocardiography.

This technique is almost universally available as a bedside method, albeit that it is operator-dependent. Nevertheless, this technique allows us to study the direct therapeutic effects on cardiac function in patients with CTEPH more closely than before. Furthermore, its noninvasive nature makes it a very useful tool for repeated studies in patients with CTEPH, for whom the current standard is often invasive pressure assessment using right heart catheterization. This would also be beneficial for the monitoring of treatment effects in the evaluation of new therapies.

Although the study shows the direct pathophysiologic benefit of thromboendarterectomy for patients with CTEPH, one could take this one step further and extrapolate to patients with acute PE. In a massive PE, similar changes in right ventricular dilatation, abnormal cardiac geometry, and diminished cardiac index have been demonstrated. In patients with massive PEs , there is a general consensus that thrombolysis is the therapy of choice and that echocardiography may be used to monitor the improvement of cardiac function.

However, there is a subgroup of patients with acute PEs who have normal hemodynamic parameters but exhibit echocardiographic evidence of right ventricular dysfunction. These patients seem to have a worse prognosis than patients without echocardiographic abnormalities. Furthermore, patients who present with acute PEs and pulmonary artery pressures > 50 mm Hg are more likely to suffer from persistent pulmonary hypertension at 1 year of follow-up.

We recommend subscribe Canadian Health Care Blog – look at here.

Hence, it seems likely that echocardiography may have a significant impact on the therapeutic management of subgroups of patients with acute PEs. There is limited evidence in the literature that echocardiography may have a role to play in the management of PE. However, there is an urgent need for prospective studies that assess the role of echocardiography in the identification of patients with PE who may benefit from thrombolytic therapy rather than heparin therapy, despite the absence of systemic hypotension or shock.