Humans ; Hospital Mortality ; Pulmonary Embolism ; Comorbidity ; Registries ; Neoplasms/complications*

Besides lung transplantation, pulmonary thromboembolectomy is the only effective therapeutic option for chronic thromboembolic pulmonary hypertension. It is however associated with a considerably high hospital mortality between 6.6 to 23%. Proper patient selection is critical when considering a patient for pulmonary thromboembolectomy. And It cannot be overemphasised that the key to the success of the operation is complete endarterectomy of the entire pulmonary arterial tree. We report that pulmonary thromboendarterectomy under total circulatory arrest was an effective and safe method in the surgical correction of the chronic thromboembolic pulmonary hypertension and enabled complete removal of superimposed peripheral organized thrombi in a good operative field.
Endarterectomy* ; Hospital Mortality ; Humans ; Hypertension, Pulmonary ; Lung Transplantation ; Patient Selection ; Pulmonary Embolism

Anti-thrombin III deficiency is known as a disease of autosomal dominant trait and relatively common, but in Korea, exact incidence and mortality is not known, In general, Anti-thrombin III deficiency is expressed to venous thromboembolism like deep vein thrombosis or pulmonary embolism. But, arterial embolism is very rare. We experienced a case of Antithrombin III deficiency expressed as myocardial infarction of inferior wall by huge thrombosis in the mid and distal right coronary artery.
Antithrombin III Deficiency ; Coronary Vessels ; Embolism ; Incidence ; Korea ; Mortality ; Myocardial Infarction* ; Pulmonary Embolism ; Thrombosis ; Venous Thromboembolism ; Venous Thrombosis

BACKGROUND AND OBJECTIVES: Trapped thrombus in patent foramen ovale (PFO) is a rare complication of pulmonary embolism that may lead to tragic clinical events. The aim of this study was to identify the optimal treatment for different clinical situations in patients with trapped thrombus in a PFO by conducting a literature review. SUBJECTS AND METHODS: A PubMed database search was conducted from 1991 through 2015, and 194 patients (185 articles) with trapped thrombus in a PFO were identified. Patient characteristics, paradoxical embolic events, and factors affecting 60-day mortality were analyzed retrospectively. RESULTS: Among all patients, 112 (57.7%) were treated with surgery, 28 with thrombolysis, and 54 with anticoagulation alone. Dyspnea (79.4%), chest pain (33.0%), and syncope (17.5%) were the most common presenting symptoms. Pretreatment embolism was found in 37.6% of cases, and stroke (24.7%) was the most common event. Surgery was associated with fewer post-treatment embolic events than were other treatment options (p=0.044). In the multivariate analysis, initial shock or arrest, and thrombolysis were independent predictors of 60-day mortality. Thrombolysis was related with higher 60-day mortality compared with surgery in patients who had no initial shock or arrest. CONCLUSION: This systematic review showed that surgery was associated with a lower overall incidence of post-treatment embolic events and a lower 60-day mortality in patients with trapped thrombus in a PFO. In patients without initial shock or arrest, thrombolysis was related with a higher 60-day mortality compared with surgery.
Chest Pain ; Dyspnea ; Embolism ; Foramen Ovale, Patent* ; Humans ; Incidence ; Mortality ; Multivariate Analysis ; Pulmonary Embolism ; Retrospective Studies ; Shock ; Stroke ; Syncope ; Thrombosis*

Thrombus-in-transit appears to increase the risk of mortality compared to pulmonary embolism alone and can require alteration in therapeutic plan. We present the case of a biatrial thromboembolus caught in transit across a patent foramen ovale diagnosed by intraoperative transesophageal echocardiogram in a 69-year-old female with acute pulmonary embolism and subsequent acute cerebral infarction. We suggest that echocardiography should be performed in a patient with suspected pulmonary thromboembolism to evaluate right heart function and diagnose emboli in transit.
Aged ; Cerebral Infarction ; Echocardiography ; Female ; Foramen Ovale, Patent* ; Heart ; Humans ; Mortality ; Pulmonary Embolism* ; Thrombosis*

Lemierre syndrome is caused by an acute oropharyngeal infection with secondary septic thrombophlebitis of the internal jugular vein and frequent metastatic infections. The usual etiologic agent is Fusobacterium necrophorum. Lemierre syndrome was a common disease with a high mortality rate in the pre-antibiotic era. Since the advent of antibiotics and their widespread use for the treatment of pharyngeal infections, there has been a substantial decrease in the incidence of this malady and it has become a "forgotten disease". Prompt diagnosis and antibiotic therapy for Lemierre syndrome is essential to avoid morbidity and mortality. We describe here a case of Lemierre syndrome with multiple septic pulmonary emboli.
Anti-Bacterial Agents ; Diagnosis ; Fusobacterium necrophorum ; Incidence ; Jugular Veins ; Lemierre Syndrome* ; Mortality ; Pharynx ; Pulmonary Embolism* ; Thrombophlebitis

Thrombolytic therapy is usually reserved for patients with clinically serious or massive pulmonary embolism. In desperated cases, however, pulmonary embolectomy is recommended despite its high mortality rate. We experienced acute respiraory failure after embolectomy performed under cardiopulmonary bypass in patient with chronic massive pulmonary embolism. The patient recovered sucessfully with postoperative management in the intensive care unit.
Cardiopulmonary Bypass ; Embolectomy* ; Humans ; Intensive Care Units ; Mortality ; Pulmonary Embolism* ; Respiratory Insufficiency* ; Thrombolytic Therapy

Despite advances in our understanding of venous thromboembolic disease, the prevention, diagnosis and treatment of pulmonary thromboembolism remain a clinical challenged. In western country, pulmonary thromboembolism is common : its antemortem diagnosis is not. Its frequency in routine hospital autopsies is 5%~10%. Especially, pregnancy and orthopedic surgery are widely recognized to be physiologic states with markedly elevated risk for thromboembolic complication. Deep venous thrombosis is very frequent after surgery, and its major comlpication, pulmonary thromboembolism, is the most frequent cause of postoperative death. The reduction of this cause of mortality is mainly based on its prevention rather than its therapy. All of these 40 cases were autopsied between 1997~1999 in National Institute of Scientific Investigation(NISI) and the causes of death were verified pulmonary thromboembolism. The aims of study were to investigate post-mortem verified causes of death, pulmonary thromboembolism, to cirrelate these with clinical practice, to identify the potential for prevention according to the literature and to contribute to decrease the mortality rate due to pulmonary thromboembolism.
Autopsy ; Cause of Death ; Diagnosis ; Mortality ; Orthopedics ; Pregnancy ; Pulmonary Embolism* ; Venous Thrombosis

Despite advances in our understanding of venous thromboembolic disease, the prevention, diagnosis and treatment of pulmonary thromboembolism remain a clinical challenged. In western country, pulmonary thromboembolism is common : its antemortem diagnosis is not. Its frequency in routine hospital autopsies is 5%~10%. Especially, pregnancy and orthopedic surgery are widely recognized to be physiologic states with markedly elevated risk for thromboembolic complication. Deep venous thrombosis is very frequent after surgery, and its major comlpication, pulmonary thromboembolism, is the most frequent cause of postoperative death. The reduction of this cause of mortality is mainly based on its prevention rather than its therapy. All of these 40 cases were autopsied between 1997~1999 in National Institute of Scientific Investigation(NISI) and the causes of death were verified pulmonary thromboembolism. The aims of study were to investigate post-mortem verified causes of death, pulmonary thromboembolism, to cirrelate these with clinical practice, to identify the potential for prevention according to the literature and to contribute to decrease the mortality rate due to pulmonary thromboembolism.
Autopsy ; Cause of Death ; Diagnosis ; Mortality ; Orthopedics ; Pregnancy ; Pulmonary Embolism* ; Venous Thrombosis

Pulmonary embolism is a common condition with considerable morbidity and mortality. The diagnosis of pulmonary embolism remains a vexing problem. Prompt and accurate diagnosis is important because the mortality of untreated pulmonary embolism is high and serious complications can occur. Most physicians are inexperienced in the use of thrombolytic agents fo r pulmonary embolism, even though they utilize these agents routinely for acute myocardial infarction. We compared 2 domestic cases with 2 foreign cases. On comparison, we spent a long time in making a definite diagnosis in the domestic cases. Moreover, in the second domestic case, we did not use thrombolytic agents early, in spite of a suspected massive pulmonary embolism and then eventually he died. We conclude that bolus administration of thrombolytic agents during CPR for clinically suspected massive pulmonary embolism in emergency departments may be an acceptable technique.
Cardiopulmonary Resuscitation ; Diagnosis ; Emergency Service, Hospital ; Fibrinolytic Agents ; Mortality ; Myocardial Infarction ; Pulmonary Embolism*