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Akut ve Kronik Pulmoner Tromboembolide Cerrahi Tecrübelerimiz

Year 2019, Volume: 46 Issue: 4, 697 - 705, 15.12.2019

Mehmet Işık , Ömer Tanyeli Yüksel Dereli Erdal Ege Niyazi Görmüş

https://doi.org/10.5798/dicletip.661262

Abstract

Giriş-Amaç: Pulmoner emboli vakaları tedavi edilmediği takdirde ani ölüm, hayatı tehdit eden akut bir durum ya da trombüslerin pulmoner damar duvarında organize olmasına bağlı olarak kronik tromboembolik pulmoner hipertansiyon gelişir. Bu çalışmada, tüm dünyada belirli merkezler dışında çok fazla sayıda yapılmayan ve mortalitesi yüksek olan pulmoner tromboendarterektomi ameliyatı ile ilgili tecrübelerimizin paylaşılması amaçlandı.
Yöntemler: Şubat 2007 - Temmuz 2018 tarihleri arasında kliniğimizde akut pulmoner emboli ve kronik tromboembolik pulmoner hipertansiyon tanılarıyla ameliyat edilen toplam 13 hasta çalışmaya dâhil edildi. Bu hastaların 9’u acil 4’ü elektif olarak ameliyata alındı. Hastalara açık kalp ameliyatı şartlarında pulmoner tromboendarterektomi cerrahi prosedürü uygulandı. Hastaların geriye dönük bilgileri hastane yazılım sisteminden elde edildi.
Bulgular: Pulmoner tromboendarterektomi uygulanan hastaların 6’sı bayan 7’si erkekti. Ortalama yaş 58 (38-71) olarak bulundu. Risk faktörü olarak 7 hastada derin ven trombozu, 3 hastada yakın zamanda geçirilmiş cerrahi, 2 hastada malinite, 5 hastada sigara kullanımı, 1 hastada behçet ve 1 hastada serebrovasküler olay öyküsü mevcuttu. Dört vaka, postoperatif 0-26 gün aralığında exitus oldu. Bunların 3’ü akut pulmoner emboli, 1’i kronik tromboembolik pulmoner hipertansiyon tanılı hastalardı.
Sonuç ve Yorum: Pulmoner tromboendarterektomi uygulanan hastaların erken dönem pulmoner arter basınçlarında belirgin düşüş izlendi. Kronik tromboembolik pulmoner hipertansiyon tanısı konan hastalar, kalıcı arteriopati gelişmeden, pulmoner tromboendarterektomi ameliyatı için cerrahi merkezlere erken dönemde yönlendirilmelidir. Akut pulmoner emboli tanısı alan hastaların cerrahiye verilme zamanlamasının önemli olduğu kanaatindeyiz. Geciken ve hipotansif şok tablosunda ameliyata alınan hastaların mortalitesi yüksek olmaktadır.

Keywords

Pulmoner emboli kronik tromboembolik pulmoner hipertansiyon

References

  • 1. Erkoçak ÖF, Erkoçak R, Kara İ, et al. Ortopedik Cerrahide İntraoperatif Masif Pulmoner Emboli. Selçuk Tıp Dergisi. 2010; 26: 150-2.
  • 2. Yücedağ E, Uysal A, Burma O, et al. Comparison of ventilation/perfusion scintigraphy and multi-detector computerized tomography in diagnosis of asymptomatic pulmonary embolism after deep vein thrombosis. Dicle Med J. 2014; 41: 179-86.
  • 3. Wong P, Baglin T. Epidemiology, risk factors and sequelae of venous thromboembolism. Phlebology. 2012; 2: 2-11.
  • 4. Spencer FA, Emery C, Joffe SW, et al. Incidence rates, clinical profile, and outcomes of patients with venous thromboembolism. The Worcester VTE study. J Thromb Thrombolysis. 2009; 28: 401-9.
  • 5. Tapson VF, Humbert M. Incidence and prevalence of chronic thromboembolic pulmonary hypertension:from acute to chronic pulmonary embolism. Proc Am Thorac Soc. 2006; 3: 564-7.
  • 6. Auger WR, Kim NH, Kerr KM, et al. Chronic thromboembolic pulmonary hypertension. Clin Chest Med. 2007; 28: 255-69.
  • 7. Ribeiro A, Lindmarker P, Johnsson H, et al. Pulmonary embolism: one year follow-up with echocardiographic Doppler and five year survival analysis. Circulation. 1999; 99: 1325-30.
  • 8. Klok F, van Kralingen KW, van Dijk APJ, et al. Prospective cardiopulmonary screening program to detect chronic thromboembolic pulmonary hypertension in patients after acute pulmonary embolism. Haematologica. 2010; 95: 970-5.
  • 9. Korkmaz A, Ozlu T, Ozsu S, et al. Long-term outcomes in acute pulmonary thromboembolism: the incidence of chronic thromboembolic pulmonary hypertension and associated risk factors. Clin Appl Thromb Hemost. 2012; 18: 281-8.
  • 10. Delcroix M. Choronic post-embolic pulmonary hypertension. Eur Respir Rev. 2013; 22: 258-64.
  • 11. Bozlar U, Gaughen JR, Nambiar AP, Hagspiel KD. Imaging diagnosis of acute pulmonary embolism. Expert Rev Cardiovasc Ther. 2007; 5: 519-29.
  • 12. Velioğlu Y, Erkut B, Ünlü Y, et al. Deep Venous Thrombosis and Treatment Procedures (Experience with 505 Patients). Turk J Vasc Surg. 2006; 15: 001-13.
  • 13. Torbicki A, Perrier A, Konstantinides SV, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J. 2008; 29: 2276-315.
  • 14. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic Therapy for VTE Disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(Suppl 2): e419S-e94S.
  • 15. Kearon C, Elie Akl, Ornelas J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016; 149: 315-52.
  • 16. Kon ZN, Pasrija C, Bittle GJ, et al. The Incidence and Outcomes of Surgical Pulmonary Embolectomy in North America. Ann Thorac Surg. 2019; 107: 1401–8.
  • 17. Yıldızeli B, Taş S, Yanartaş M, et al. Pulmonary endarterectomy for chronic thrombo-embolic pulmonary hypertension: an institutional experience. Eur J Cardiothorac Surg. 2013; 44: 219-27.
  • 18. Riedel M, Stanek V, Widimsky J, Prerovsky I. Longterm follow-up of patients with pulmonary thromboembolism. Late prognosis and evolution of hemodynamic and respiratory data. Chest. 1982; 81: 151-8.
  • 19. Lewczuk J, Piszko P, Jagas J, et al. Prognostic factors in medically treated patients with chronic pulmonary embolism. Chest. 2001; 119: 818-23.
  • 20. Madani MM, Auger WR, Pretorius V, et al. Pulmonary endarterectomy: recent changes in a single institution’s experience of more than 2700 patient. Ann Thorac Surg. 2012; 94: 97-103.
  • 21. Dartevelle P, Fadel E, Mussot S, et al. Chronic thromboembolic pulmonary hypertension. Eur Respir J. 2004; 23: 637-48.
  • 22. Ghofrani HA, D’Armini A, Grimminger F, et al. Riociguat for the treatment of chronic thromboembolic pulmonary hypertension. N Engl J Med. 2013; 369: 319-29.
  • 23. Oh SJ, Bok JS, Hwang HY, Kim KH, Kim KB. Clinical out- comes of thromboendarterectomy for chronic thromboembolic pulmonary hypertension: 12-year experience. Korean J Thorac Cardiovasc Surg. 2013; 46: 41-8.
  • 24. Mellemkjaer S, Ilkjaer LB, Klaaborg KE, et al. Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. Ten years experience in Denmark. Scand Cardiovasc J. 2006; 40: 49-53.
  • 25. Freed DH, Thomson BM, Berman M, et al. Survival after pulmonary thromboendarterectomy: effect of residual pulmonary hypertension. J Thorac Cardiovasc Surg. 2011; 141: 383-7.
  • 26. Yanartaş M, Acar RD, Yıldızeli B. The Pulmonary Thromboendarterectomy Increases Gradually All Over the World; Review. Koşuyolu Heart Journal. 2016; 19: 184-90.
  • 27. Hoeper MM, Mayer E, Simonneau G, Rubin LJ. Chronic thromboembolic pulmonary hypertension. Circulation. 2006; 113: 2011-20.
  • 28. Mares P, Gilbert TB, Tschernko EM, et all. Pulmonary artery thromboendarterectomy: a comparison of two different postoperative treatment strategies. Anesth Analg. 2000; 90: 267-73.
  • 29. Pasrija C, Kronfli A, George P, et al. Utilization of veno-arterial extracorporeal membrane oxygenation for massive pulmonary embolism. Ann Thorac Surg. 2018; 105: 498-504.
  • 30. Menzel T, Kramm T, Wagner S, et al. Improvement of tricuspid regurgitation after pulmonary thromboendarterectomy. Ann Thorac Surg. 2002; 73: 756-61.
  • 31. Sadeghi HM, Kimura BJ, Raisinghani A, et al. Does lowering pulmonary arterial pressure eliminate severe functional tricuspid regurgitation? Insights from pulmonary thromboendarterectomy. J Am Coll Cardiol. 2004; 44: 126-32.

Year 2019, Volume: 46 Issue: 4, 697 - 705, 15.12.2019

Mehmet Işık , Ömer Tanyeli Yüksel Dereli Erdal Ege Niyazi Görmüş

https://doi.org/10.5798/dicletip.661262

Abstract

References

  • 1. Erkoçak ÖF, Erkoçak R, Kara İ, et al. Ortopedik Cerrahide İntraoperatif Masif Pulmoner Emboli. Selçuk Tıp Dergisi. 2010; 26: 150-2.
  • 2. Yücedağ E, Uysal A, Burma O, et al. Comparison of ventilation/perfusion scintigraphy and multi-detector computerized tomography in diagnosis of asymptomatic pulmonary embolism after deep vein thrombosis. Dicle Med J. 2014; 41: 179-86.
  • 3. Wong P, Baglin T. Epidemiology, risk factors and sequelae of venous thromboembolism. Phlebology. 2012; 2: 2-11.
  • 4. Spencer FA, Emery C, Joffe SW, et al. Incidence rates, clinical profile, and outcomes of patients with venous thromboembolism. The Worcester VTE study. J Thromb Thrombolysis. 2009; 28: 401-9.
  • 5. Tapson VF, Humbert M. Incidence and prevalence of chronic thromboembolic pulmonary hypertension:from acute to chronic pulmonary embolism. Proc Am Thorac Soc. 2006; 3: 564-7.
  • 6. Auger WR, Kim NH, Kerr KM, et al. Chronic thromboembolic pulmonary hypertension. Clin Chest Med. 2007; 28: 255-69.
  • 7. Ribeiro A, Lindmarker P, Johnsson H, et al. Pulmonary embolism: one year follow-up with echocardiographic Doppler and five year survival analysis. Circulation. 1999; 99: 1325-30.
  • 8. Klok F, van Kralingen KW, van Dijk APJ, et al. Prospective cardiopulmonary screening program to detect chronic thromboembolic pulmonary hypertension in patients after acute pulmonary embolism. Haematologica. 2010; 95: 970-5.
  • 9. Korkmaz A, Ozlu T, Ozsu S, et al. Long-term outcomes in acute pulmonary thromboembolism: the incidence of chronic thromboembolic pulmonary hypertension and associated risk factors. Clin Appl Thromb Hemost. 2012; 18: 281-8.
  • 10. Delcroix M. Choronic post-embolic pulmonary hypertension. Eur Respir Rev. 2013; 22: 258-64.
  • 11. Bozlar U, Gaughen JR, Nambiar AP, Hagspiel KD. Imaging diagnosis of acute pulmonary embolism. Expert Rev Cardiovasc Ther. 2007; 5: 519-29.
  • 12. Velioğlu Y, Erkut B, Ünlü Y, et al. Deep Venous Thrombosis and Treatment Procedures (Experience with 505 Patients). Turk J Vasc Surg. 2006; 15: 001-13.
  • 13. Torbicki A, Perrier A, Konstantinides SV, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J. 2008; 29: 2276-315.
  • 14. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic Therapy for VTE Disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(Suppl 2): e419S-e94S.
  • 15. Kearon C, Elie Akl, Ornelas J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016; 149: 315-52.
  • 16. Kon ZN, Pasrija C, Bittle GJ, et al. The Incidence and Outcomes of Surgical Pulmonary Embolectomy in North America. Ann Thorac Surg. 2019; 107: 1401–8.
  • 17. Yıldızeli B, Taş S, Yanartaş M, et al. Pulmonary endarterectomy for chronic thrombo-embolic pulmonary hypertension: an institutional experience. Eur J Cardiothorac Surg. 2013; 44: 219-27.
  • 18. Riedel M, Stanek V, Widimsky J, Prerovsky I. Longterm follow-up of patients with pulmonary thromboembolism. Late prognosis and evolution of hemodynamic and respiratory data. Chest. 1982; 81: 151-8.
  • 19. Lewczuk J, Piszko P, Jagas J, et al. Prognostic factors in medically treated patients with chronic pulmonary embolism. Chest. 2001; 119: 818-23.
  • 20. Madani MM, Auger WR, Pretorius V, et al. Pulmonary endarterectomy: recent changes in a single institution’s experience of more than 2700 patient. Ann Thorac Surg. 2012; 94: 97-103.
  • 21. Dartevelle P, Fadel E, Mussot S, et al. Chronic thromboembolic pulmonary hypertension. Eur Respir J. 2004; 23: 637-48.
  • 22. Ghofrani HA, D’Armini A, Grimminger F, et al. Riociguat for the treatment of chronic thromboembolic pulmonary hypertension. N Engl J Med. 2013; 369: 319-29.
  • 23. Oh SJ, Bok JS, Hwang HY, Kim KH, Kim KB. Clinical out- comes of thromboendarterectomy for chronic thromboembolic pulmonary hypertension: 12-year experience. Korean J Thorac Cardiovasc Surg. 2013; 46: 41-8.
  • 24. Mellemkjaer S, Ilkjaer LB, Klaaborg KE, et al. Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. Ten years experience in Denmark. Scand Cardiovasc J. 2006; 40: 49-53.
  • 25. Freed DH, Thomson BM, Berman M, et al. Survival after pulmonary thromboendarterectomy: effect of residual pulmonary hypertension. J Thorac Cardiovasc Surg. 2011; 141: 383-7.
  • 26. Yanartaş M, Acar RD, Yıldızeli B. The Pulmonary Thromboendarterectomy Increases Gradually All Over the World; Review. Koşuyolu Heart Journal. 2016; 19: 184-90.
  • 27. Hoeper MM, Mayer E, Simonneau G, Rubin LJ. Chronic thromboembolic pulmonary hypertension. Circulation. 2006; 113: 2011-20.
  • 28. Mares P, Gilbert TB, Tschernko EM, et all. Pulmonary artery thromboendarterectomy: a comparison of two different postoperative treatment strategies. Anesth Analg. 2000; 90: 267-73.
  • 29. Pasrija C, Kronfli A, George P, et al. Utilization of veno-arterial extracorporeal membrane oxygenation for massive pulmonary embolism. Ann Thorac Surg. 2018; 105: 498-504.
  • 30. Menzel T, Kramm T, Wagner S, et al. Improvement of tricuspid regurgitation after pulmonary thromboendarterectomy. Ann Thorac Surg. 2002; 73: 756-61.
  • 31. Sadeghi HM, Kimura BJ, Raisinghani A, et al. Does lowering pulmonary arterial pressure eliminate severe functional tricuspid regurgitation? Insights from pulmonary thromboendarterectomy. J Am Coll Cardiol. 2004; 44: 126-32.
There are 31 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Research Article
Authors

Mehmet Işık 0000-0002-2154-7473

Ömer Tanyeli This is me 0000-0001-6275-7744

Yüksel Dereli This is me 0000-0002-3794-1045

Erdal Ege This is me 0000-0002-6192-4915

Niyazi Görmüş This is me 0000-0002-8264-3653

Publication Date December 15, 2019
Submission Date May 3, 2019
Published in Issue Year 2019 Volume: 46 Issue: 4

Cite

APA Işık, M., Tanyeli, Ö., Dereli, Y., Ege, E., et al. (2019). Akut ve Kronik Pulmoner Tromboembolide Cerrahi Tecrübelerimiz. Dicle Medical Journal, 46(4), 697-705. https://doi.org/10.5798/dicletip.661262
AMA Işık M, Tanyeli Ö, Dereli Y, Ege E, Görmüş N. Akut ve Kronik Pulmoner Tromboembolide Cerrahi Tecrübelerimiz. diclemedj. December 2019;46(4):697-705. doi:10.5798/dicletip.661262
Chicago Işık, Mehmet, Ömer Tanyeli, Yüksel Dereli, Erdal Ege, and Niyazi Görmüş. “Akut Ve Kronik Pulmoner Tromboembolide Cerrahi Tecrübelerimiz”. Dicle Medical Journal 46, no. 4 (December 2019): 697-705. https://doi.org/10.5798/dicletip.661262.
EndNote Işık M, Tanyeli Ö, Dereli Y, Ege E, Görmüş N (December 1, 2019) Akut ve Kronik Pulmoner Tromboembolide Cerrahi Tecrübelerimiz. Dicle Medical Journal 46 4 697–705.
IEEE M. Işık, Ö. Tanyeli, Y. Dereli, E. Ege, and N. Görmüş, “Akut ve Kronik Pulmoner Tromboembolide Cerrahi Tecrübelerimiz”, diclemedj, vol. 46, no. 4, pp. 697–705, 2019, doi: 10.5798/dicletip.661262.
ISNAD Işık, Mehmet et al. “Akut Ve Kronik Pulmoner Tromboembolide Cerrahi Tecrübelerimiz”. Dicle Medical Journal 46/4 (December 2019), 697-705. https://doi.org/10.5798/dicletip.661262.
JAMA Işık M, Tanyeli Ö, Dereli Y, Ege E, Görmüş N. Akut ve Kronik Pulmoner Tromboembolide Cerrahi Tecrübelerimiz. diclemedj. 2019;46:697–705.
MLA Işık, Mehmet et al. “Akut Ve Kronik Pulmoner Tromboembolide Cerrahi Tecrübelerimiz”. Dicle Medical Journal, vol. 46, no. 4, 2019, pp. 697-05, doi:10.5798/dicletip.661262.
Vancouver Işık M, Tanyeli Ö, Dereli Y, Ege E, Görmüş N. Akut ve Kronik Pulmoner Tromboembolide Cerrahi Tecrübelerimiz. diclemedj. 2019;46(4):697-705.