Management of right heart thrombi associated with acute pulmonary embolism: A retrospective, single-center experience

ARIBAŞ, Alpay; ERDOĞAN, Halil İbrahim; ÖZDEMİR, Kurtuluş; AKILLI, Hakan; Gul, Enes; KAYRAK, Mehmet

Management of right heart thrombi associated with acute pulmonary embolism: A retrospective, single-center experience

Hakan AKILLI, (Konya Üniversitesi, Meram Tıp Fakültesi, Kardiyoloji Kliniği, Konya, Türkiye)

Enes Elvin GÜL, (Konya Üniversitesi, Meram Tıp Fakültesi, Kardiyoloji Kliniği, Konya, Türkiye)

Alpay ARIBAŞ, (Konya Üniversitesi, Meram Tıp Fakültesi, Kardiyoloji Kliniği, Konya, Türkiye)

Kurtuluş ÖZDEMİR, (Konya Üniversitesi, Meram Tıp Fakültesi, Kardiyoloji Kliniği, Konya, Türkiye)

Mehmet KAYRAK, (Konya Üniversitesi, Meram Tıp Fakültesi, Kardiyoloji Kliniği, Konya, Türkiye)

Halil İbrahim ERDOĞAN (Konya Üniversitesi, Meram Tıp Fakültesi, Kardiyoloji Kliniği, Konya, Türkiye)

Anadolu Kardiyoloji Dergisi

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Yıl: 2013 Cilt: 13 Sayı: 6 Sayfa Aralığı: 528 - 533 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Management of right heart thrombi associated with acute pulmonary embolism: A retrospective, single-center experience

Öz:

Amaç: Pulmoner emboli (PE) ile ilişkili sağ kalp trombüslerinin mortalitesi 3-4 kat artmaktadır. En korkulan senaryo ise sağ kalp trombüslerinin parçalanması sonucunda rekürren pulmoner emboli gelişmesidir. Pulmoner embolilere eşlik eden sağ kalp trombüsü vakalarının tedavisi zordur ve bu konu ile ilgili literatürde yeterli veri bulunmamaktadır. Yöntemler: Ocak 2006 ila Aralık 2011 tarihleri arasında akut pulmoner emboli tanısı almış 312 hastanın verileri retrospektif olarak incelendi. Bilgisayarlı tomografi ile tanı almış 312 akut PE hastalarından ekokardiyografide sağ kalp trombüsü bulunan 35 hasta çalışmaya alındı. Metastatik malignansi bulunan 6 hasta çalışmadan dışlandı. Yirmi dokuz hasta değerlendirilme için uygun bulundu. Hastaların ekokardiyografik raporları da incelendi. Ayrıca katetere bağlı gelişen trombüs (tip B) vakaları da çalışmaya dahil edilmedi. Kategorik değişkenlerin karşılaştırılmasında Ki-kare ve non-parametrik sürekli değişkenlerin karşılaştırılmasında ise Mann-Whitney U testleri kullanıldı. P değerinin 0,05’in altında olması istatistik- sel olarak anlamlı kabul edildi. Bulgular: Hastaların mortalite oranı yüksek bulundu (%34): cerrahi mortalite %100, trombolitik alanlardaki mortalite %18 ve heparin alanlarda mortalite %27 bulundu. Ölen hastalardaki troponin düzeyleri hayatta kalan hastalara göre anlamlı olarak yüksek bulundu (p=0,03). Heparin alan- larla trombolitik tedavi uygulanan gruplar arasında klinik ve ekokardiyografik olarak anlamlı fark saptanmadı. Fark sadece şok indeksinde saptandı (p=0,02). Ek olarak heparin alan hastaların yatış süresi trombolitik alanlara göre anlamlı olarak uzun bulundu (ortanca olarak 8 güne karşın 3 gün, p<0,01). Sonuç: Akut pulmoner emboliye eşlik eden sağ kalp trombüsü vakalarının insidansının düşük olmasına rağmen mortalitelerinin yüksek seyretmesi halen önemli bir problem olarak kalmaktadır. Tedavi modalite seçiminde hastanın hemodinamik değerleri, laboratuvar parametreleri ve kanama riskleri esas alınarak karar verilmelidir.

Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi

Akut pulmoner emboliye eşlik eden sağ kalp trombüslerine yaklaşım: Retrospektif ve tek merkez deneyimi

Öz:

Objective: The mortality of right heart thrombi (RHT) associated with pulmonary embolism (PE) is increased about three to four times. The most devastating scenario is fragmentation of RHT and occurrence of recurrent PE. The reports regarding the management of RHT complicated with PE are very scarce in the current literature. Therefore, we report a single-center experience in this paper. Methods: From January 2006 to December 2011, data of all patients diagnosed with acute PE were analyzed retrospectively. Of the 312 acute PE cases confirmed with computed tomography, total 35 patients who were diagnosed with concomitant RHT (prevalence of 11%) by echocar- diography were recruited. After excluding of six patients with metastatic malignancy a total 29 patients were accepted eligible for the analysis. In addition, catheter -induced thrombus (type B) were not included to the study. The difference between categorical variables was analyzed with Chi-square test and continuous variables were analyzed with Mann-Whitney U test. A p value of <0.05 was considered statistically sig- nificant. Results: Overall mortality was high (34%) in study population: among undergoing surgery-100%, therapy with thrombolytics -18%, and heparin -27%. Troponin levels were found significantly higher in died patients than that in survived patients (p=0.03). There was no significant difference regarding to clinical and echocardiographic characteristics of patients received heparin versus thrombolytic except for shock index (p=0.02). In addition, patients treated with heparin had increased duration of hospitalization compared to subjects treated with thrombolytic (median: 8 vs 3 days p<0.01). Conclusion: Despite of the low incidence of RHT, a mortal course is still an important problem during PE. The decision on treatment modality should be performed based on the hemodynamic parameters, laboratory findings, and bleeding risk of the patients.

Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi

Belge Türü: Makale Makale Türü: Editoryal Erişim Türü: Erişime Açık

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APA	AKILLI H, Gul E, ARIBAŞ A, ÖZDEMİR K, KAYRAK M, ERDOĞAN H (2013). Management of right heart thrombi associated with acute pulmonary embolism: A retrospective, single-center experience. , 528 - 533.
Chicago	AKILLI Hakan,Gul Enes,ARIBAŞ Alpay,ÖZDEMİR Kurtuluş,KAYRAK Mehmet,ERDOĞAN Halil İbrahim Management of right heart thrombi associated with acute pulmonary embolism: A retrospective, single-center experience. (2013): 528 - 533.
MLA	AKILLI Hakan,Gul Enes,ARIBAŞ Alpay,ÖZDEMİR Kurtuluş,KAYRAK Mehmet,ERDOĞAN Halil İbrahim Management of right heart thrombi associated with acute pulmonary embolism: A retrospective, single-center experience. , 2013, ss.528 - 533.
AMA	AKILLI H,Gul E,ARIBAŞ A,ÖZDEMİR K,KAYRAK M,ERDOĞAN H Management of right heart thrombi associated with acute pulmonary embolism: A retrospective, single-center experience. . 2013; 528 - 533.
Vancouver	AKILLI H,Gul E,ARIBAŞ A,ÖZDEMİR K,KAYRAK M,ERDOĞAN H Management of right heart thrombi associated with acute pulmonary embolism: A retrospective, single-center experience. . 2013; 528 - 533.
IEEE	AKILLI H,Gul E,ARIBAŞ A,ÖZDEMİR K,KAYRAK M,ERDOĞAN H "Management of right heart thrombi associated with acute pulmonary embolism: A retrospective, single-center experience." , ss.528 - 533, 2013.
ISNAD	AKILLI, Hakan vd. "Management of right heart thrombi associated with acute pulmonary embolism: A retrospective, single-center experience". (2013), 528-533.

APA	AKILLI H, Gul E, ARIBAŞ A, ÖZDEMİR K, KAYRAK M, ERDOĞAN H (2013). Management of right heart thrombi associated with acute pulmonary embolism: A retrospective, single-center experience. Anadolu Kardiyoloji Dergisi, 13(6), 528 - 533.
Chicago	AKILLI Hakan,Gul Enes,ARIBAŞ Alpay,ÖZDEMİR Kurtuluş,KAYRAK Mehmet,ERDOĞAN Halil İbrahim Management of right heart thrombi associated with acute pulmonary embolism: A retrospective, single-center experience. Anadolu Kardiyoloji Dergisi 13, no.6 (2013): 528 - 533.
MLA	AKILLI Hakan,Gul Enes,ARIBAŞ Alpay,ÖZDEMİR Kurtuluş,KAYRAK Mehmet,ERDOĞAN Halil İbrahim Management of right heart thrombi associated with acute pulmonary embolism: A retrospective, single-center experience. Anadolu Kardiyoloji Dergisi, vol.13, no.6, 2013, ss.528 - 533.
AMA	AKILLI H,Gul E,ARIBAŞ A,ÖZDEMİR K,KAYRAK M,ERDOĞAN H Management of right heart thrombi associated with acute pulmonary embolism: A retrospective, single-center experience. Anadolu Kardiyoloji Dergisi. 2013; 13(6): 528 - 533.
Vancouver	AKILLI H,Gul E,ARIBAŞ A,ÖZDEMİR K,KAYRAK M,ERDOĞAN H Management of right heart thrombi associated with acute pulmonary embolism: A retrospective, single-center experience. Anadolu Kardiyoloji Dergisi. 2013; 13(6): 528 - 533.
IEEE	AKILLI H,Gul E,ARIBAŞ A,ÖZDEMİR K,KAYRAK M,ERDOĞAN H "Management of right heart thrombi associated with acute pulmonary embolism: A retrospective, single-center experience." Anadolu Kardiyoloji Dergisi, 13, ss.528 - 533, 2013.
ISNAD	AKILLI, Hakan vd. "Management of right heart thrombi associated with acute pulmonary embolism: A retrospective, single-center experience". Anadolu Kardiyoloji Dergisi 13/6 (2013), 528-533.