Posts Tagged ‘thromboendarterectomy

Pulmonary Vascular Steal in Chronic Thromboembolic Pulmonary Hypertension: Discussion (5)The vascular endothelium has been shown to secrete vasodilatory and vasoconstrictor substances. In the setting of experimental endothelial stripping or carotid endarterectomy, the vascular endothelium has been shown to regenerate, forming a coherent layer in seven to ten days. However, morphologic […]

A more comprehensive explanation can be supported by the following two observations: (1) the normal preoperative scan and angiogram in most patients with “steal” and the normal follow-up angiograms available in some, and (2) pathologic examination of lung biopsy specimens in a number of these patients that have shown extensive pulmonary hypertensive changes in the small distal arteries*— changes not detectable by routine angiography. We speculate that these changes, like […]

Pulmonary Vascular Steal in Chronic Thromboembolic Pulmonary Hypertension: Discussion (3)Segmental atelectasis and postoperative reperfusion edema could be causes of new perfusion scan defects in our patient population. Both pulmonary parenchymal abnormalities have been reported to induce regional decrements in flow. However, the steal zones have been consistently free of parenchymal infiltrates […]

Our initial concern when this phenomenon was first seen was that in situ thrombosis or embolic recurrence might have occurred perioperatively. Our analysis and other considerations make these possibilities unlikely. First, these patients are routinely protected by preoperative or intraoperative placement of a caval Greenfield filter, and lower extremity pneumatic compression plus heparin prophylaxis are begun in the immediate postoperative period. These measures should render perioperative embolism or rethrombosis low […]

Pulmonary Vascular Steal in Chronic Thromboembolic Pulmonary Hypertension: Discussion (1)The major finding in our study is the frequent occurrence of new postoperative, segmental, perfusion scan abnormalities in lung zones served by angiographically patent, undissected pulmonary arteries. cialis professional
The appearance of […]

Patients ranged in age from 20 to 70 years (45 ± 15 years) with a male to female ratio of 1.1:1. The preoperative and postoperative hemodynamic data in the 33 patients are presented in Table 1. Significant declines in pulmonary artery mean pressure and pulmonary vascular resistance, as well as a rise in cardiac output, were noted postoperatively. Buy Advair Diskus Online
All patients underwent a pulmonary thromboendarterectomy. However, in 27 patients, […]

Pulmonary Vascular Steal in Chronic Thromboembolic Pulmonary Hypertension: Methods (2)The perfusion to each anatomic segment was visually scored as normal (2.0), decreased (0.5 to 1.5), or absent (0). Only those segments with normal ventilation were ranked. Steal was noted to have occurred […]

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