• Tuberculosis and Respiratory Diseases
• /
• v.59 no.5
• /
• pp.487-496
• /
• 2005

Background : 'Major pulmonary thromboembolism' is defined as right ventricular (RV) dysfunction, with or without shock, accompanied by significant morbidity and mortality. In this study, those with major pulmonary thromboembolism were divided into the shock and RV dysfunction only groups, and then investigated the mortality and complications in thrombolysis or anticoagulation, respectively. Methods : In a retrospective study, between January 1995 and December 2004, 60 eligible patients with a major pulmonary thromboembolism, admitted in Asan Medical Center, were included. Results : A total of 57 patients were treated with medical therapy. Thrombolysis was performed in 13 patients (23%) and anticoagulation in 44 (77%). There were no differences in the APACHEII and SOFA scores between the two groups. 6 (46%) and 11 (25%) patients died in the thrombolysis and anticoagulation groups, respectively (p=0.176). In the 19 patients (33%) showing shock, thrombolysis was performed in 9 (47%) and anticoagulation in 10 (53%). 4 (44%) of the 9 patients treated with thrombolytic agents and 3 (30%) of the 10 treated with anticoagulants died (p=0.650). In the 38 patients (67%) showing RV dysfunction only, thrombolysis was performed in 4 (11%) and anticoagulation in 34 (89%). 2 (50%) of the 4 patients treated with thrombolytics and 8 (24%) of the 34 treated with anticoagulants died (p=0.279). Three patients (23%) who underwent thrombolysis had a major bleeding episode, compared with 2 (5%) who were treated with anticoagulants (p=0.072). Conclusion: The results of our study showed that thrombolysis did not lower mortality and tended to increase major bleeding compared with anticoagulation in both the shock and RV dysfunction only groups. Further evaluation of the efficacy and safety of thrombolytic therapy for major thromboembolism appears warranted in Korea.

• Journal of Chest Surgery
• /
• v.22 no.6
• /
• pp.980-989
• /
• 1989

The Hancock porcine xenograft valves had been used in Seoul National University Hospital, mainly because of their antithrombogenicity despite of the predicted failure, from March 1976 to April 1984, and a total and consecutive 163 patients were retrospectively studied for late results with the special stress on the structural failure. The hospital mortality rate [within 30 days] was 6.1 %, and the 153 early survivors were followed up for a total of 822.9 patient-years [p-y][Mean * SD 5.38 * 3.02 years]. The linealized late mortality was 1.823%/p-y. Four major complications related to the Hancock valve were: 1.822% thromboembolism/p-y; 0.729 % bleeding/p-y; 0.972% endocarditis/p-y; 3.646% overall valve failure/p-y and 2.187 % primary tissue failure [PTF]/p-y. The actuarial survival rates at 5 and 10 years were 94.90 * 1.89% and 80.58 * 5.21 %; and the probabilities of freedom from thromboembolism at 5 and 10 years were 90.93 * 2.63% and 83.35 * 7.64 9o respectively. The probabilities from PTF at 5, 10 and 12 years were 98.02 * 1.39%, 60.62 * 8.89% and 49.60 * 12.34 %. One hundred-eighteen patients [72.4%] had single MVR [age, 34.0 * 10.9 years] with the operative mortality rate of 4.2%; and 113 early survivors were followed up for a total 616.4 patient-years[5.46 * 2.96 years]. The late mortality rate was 1.460 %/p-y. The major complications were: 1.622 % thromboembolism /p-y; 0.487% bleeding/p-y; 0.649 % endocarditis/p-y; 2.920% primary valve failure/p y and 1.785% PTF/p-y. The actuarial survival rates were 97.08 * 1.67%[at 5 years] and 81.27 * 6.64%[at 10 years], and the probabilities of freedom from thromboembolism 92.44 * 2.76 %[at 5 years] and 80.89 * 11.08%[at 10 years]. The probabilities of freedom from PTF at 5 and 10 years were 98 70 * 1.29% and 65.59 * 9.78% respectively. The mean age of 11 patients of PTF was 25.7 * 8.8 years and the valve extraction period 7.16 * 1.45 years. Failure of bioprosthetic xenograft valves are reportedly known to occur earlier in young patients in an accelerated fashion. The study with two groups divided into the cumulative younger and the cumulative older patients according to the age limits of 5-year interval strongly suggested these tendency. Although PTF began to occur past postoperative 5 years and the probabilities of freedom from PTF increased as the age limits raised and the number of patients increased in the cumulative younger patients while they decreased as the age limits lowered and the number of patients increased in the cumulative older patients, the definite age limits from which the Hancock valve can be safely recommended could not be obtained. From the results, the Hancock valves are contraindicated in patients younger than 20 to 25 years and may be safely recommended in patients older than 45 years as a tentative conclusion. Further longitudinal study may define these age factors.

• Journal of Chest Surgery
• /
• v.44 no.3
• /
• pp.220-224
• /
• 2011

Background: We investigated changes in the International Normalized Ratio (INR) and its measurement interval in patients with thromboembolic events who were treated by low intensity anticoagulation therapy after isolated mechanical aortic valve replacement. Materials and Methods: Seventy-seven patients who underwent surgery from June 1990 to September 2006 were enrolled in the study and observed until August 2008. The patients were followed up at 4~8 week intervals and their warfarin (Coumadin)$^{(R)}$ dosage was adjusted aiming for a target range of INR 1.5~2.5. The rate of thromboembolic events was obtained. Changes in the mean INR and INR measurement interval were comparatively analyzed between the normal group (event free group, N=52) who had no anticoagulation-related complications and the thromboembolic group (N=10). Hospital records were reviewed retrospectively. Results: The observation period was 666.75 patient-years. Thromboembolic events occurred in 10 patients. The linearized occurrence rate of thromboembolism was 1.50%/patient-years. Actuarial thromboembolism-free rates were $97.10{\pm}2.02%$ at 5 years, $84.30{\pm}5.22%$ at 10 years, and $67.44{\pm}12.14%$ at 15 years. The percentages of INR within the target range and mean INR were not statistically significantly different for the normal and thromboembolic groups. However, the mean INR during the segmented period just before the events showed a significantly lower level in the thromboembolic group (during a 4 month period: normal group, $1.86{\pm}0.14$ vs. thromboembolic group, $1.50{\pm}0.28$, p<0.001). The mean intervals of INR measurement during the whole observation period showed no significant differences between groups, but in the segmented period just before the events, the interval was significantly longer in thromboembolic group (during a 6 month period: normal group, $49.04{\pm}9.47$ days vs. thromboembolic group, $65.89{\pm}44.88$ days, p<0.01). Conclusion: To prevent the occurrence of thromboembolic events in patients who receive isolated aortic valve replacement and low intensity anticoagulation therapy, we suggest that it would be safe to maintain an INR level above 1.8 and to measure the INR at least every 7~8 weeks.

• Tuberculosis and Respiratory Diseases
• /
• v.54 no.1
• /
• pp.5-14
• /
• 2003

Background : According to the study in ICOPER (International Cooperative Pulmonary Embolism Registry), the overall mortality rate of acute pulmonary thromboembolism (APTE) at 3 months is 17.4%. According to the study for current status of APTE in Japan, the hospital mortality rate is 14%. Although the incidence and mortality rate of APTE has been increasing, patient characteristics, management strategies, and outcome of APTE in the Korean population have not yet been assessed in large series. We therefore performed the national survey for the current status of APTE in the Korean population. Methods : 808 registry patients with APTE were analyzed with respect to clinical characteristics, risk factors, diagnostic procedures, treatment, and clinical outcome. Results : Main risk factors were immobilization, recent major surgery, and cancer. Common symptoms were dyspnea and chest pain. Common signs were tachypnea and tachycardia. The majority of registry patients underwent lung perfusion scanning. Spiral CT was used in 309 patients(42.9%), and angiography in 48 patients(7.9%). Heparin was the most widely used treatment. On multivariate logistic regression analysis, onset in hospital (odds ratio 1.88, p=0.0385), lung cancer (odds ratio 9.20, p=0.0050), tachypnea (odds ratio 3.50, p=0.0001), shock (odds ratio 6.74, p=0.0001), and cyanosis (odds ratio 3.45, p=0.0153) were identified as significant prognostic factors. The overall mortality rate was 16.9% and mortality associated with APTE was 9.0%. Conclusions : The present registry demonstrated the clinical characteristics, diagnostic strategies, management and outcome of patient with APTE in Korea. The mortality rate was 9.0%, and the predictors of mortality were onset in hospital, lung cancer, tachypnea, shock, and cyanosis. These results may be important for risk stratification as well as for the identification of potential candidates for more aggressive treatment.

• Journal of Chest Surgery
• /
• v.11 no.3
• /
• pp.303-315
• /
• 1978

During the full 10-year period from June 1968 through June 1978, 112 consecutive patients underwent isolated or double valve replacement. A total of 130 valves were used in aortic, mitral or tricuspid positions: 63 prosthetic valves in 56 and 67 glutaraldehyde-preserved porcine aortic valves in 56 patients. There were 31 early and 9 late deaths with a cumulative mortality rate of 35.7 percent. Eighty-five patients survived longer than 10 days postoperatively were studied for the occurrence of thromboembolism and complications related to anticoagulant therapy. At the end of follow-up period, 68 patients were on Coumadin; 74 were on Persantin with or without Coumadin; 11 were off any antithrombotic drugs with 6 of them being off electively after 6 months of tissue valve replacement. Thromboembolism occurred in 7 [8.2%] of 85 patients or 10.9%/patient-year. Embolic rates were as follows: one of 18 patients anticoagulated [5.6%] or 6.1%/patient-year and 4 of 16 patients not anticoagulated [25.0%] or 17.8%/patient-year for the prosthetic valve replacement; and one of 40 patients anticoagulated [2.5%] or 7.9%/patient-year and one of 11 patients not anticoagulated [9.1%] or 7.9%/patient-year for tissue valve replacement. Three complications of major bleeding were experienced by 3 patients during the follow-up period, being related to Coumadin therapy. The importance of proper anticoagulation were stressed for the successful management of patients after cardiac valve replacement, both prosthetic and tissue valves.

• Tuberculosis and Respiratory Diseases
• /
• v.52 no.3
• /
• pp.288-293
• /
• 2002

A 32-year-old woman presented with cough and hemoptysis. The radiologic findings showed increased interstitial markings in the right lung, a slightly decreased lung volume in the RLL and a hypoplastic right pulmonary artery with collaterals in the mediastinum and subpleural area. The pulmonary angiography showed an abrupt occlusion of the right lower pulmonary artery. The echocardiographic findings indicated pulmonary hypertension. A doppler leg ultrasonograph disclosed that the left popliteal vein was occluded with collateral veins, not filling the defect in the venous lumen. The D-dimer increased 1.0 ug/ml. This condition was initially misdiagnosed as a congenital pulmonary artery agenesis. Finally, a chronic pulmonary thromboembolism with a deep vein thrombosis was confirmed.

• Clinical and Experimental Pediatrics
• /
• v.54 no.8
• /
• pp.322-328
• /
• 2011

Nephrotic syndrome (NS) is one of the most common glomerular diseases that affect children. Renal histology reveals the presence of minimal change nephrotic syndrome (MCNS) in more than 80% of these patients. Most patients with MCNS have favorable outcomes without complications. However, a few of these children have lesions of focal segmental glomerulosclerosis, suffer from severe and prolonged proteinuria, and are at high risk for complications. Complications of NS are divided into two categories: disease-associated and drug-related complications. Disease-associated complications include infections (e.g., peritonitis, sepsis, cellulitis, and chicken pox), thromboembolism (e.g., venous thromboembolism and pulmonary embolism), hypovolemic crisis (e.g., abdominal pain, tachycardia, and hypotension), cardiovascular problems (e.g., hyperlipidemia), acute renal failure, anemia, and others (e.g., hypothyroidism, hypocalcemia, bone disease, and intussusception). The main pathomechanism of disease-associated complications originates from the large loss of plasma proteins in the urine of nephrotic children. The majority of children with MCNS who respond to treatment with corticosteroids or cytotoxic agents have smaller and milder complications than those with steroid-resistant NS. Corticosteroids, alkylating agents, cyclosporin A, and mycophenolate mofetil have often been used to treat NS, and these drugs have treatment-related complications. Early detection and appropriate treatment of these complications will improve outcomes for patients with NS.

• Biomolecules & Therapeutics
• /
• v.24 no.6
• /
• pp.659-664
• /
• 2016

Lindera obtusiloba has been used in traditional herbal medicine for the treatment of blood stasis and inflammation. The leaves of Lindera obtusiloba have been reported to exhibit various physiological activities. However, there is little information available on their antiplatelet and antithrombotic activities. Thus, the present study aimed to evaluate the effect of Lindera obtusiloba leaf extract (LLE) on platelet activities, coagulation and thromboembolism. In a platelet aggregation study, LLE significantly inhibited various agonist-induced platelet aggregations in vitro and ex vivo. Furthermore, LLE significantly inhibited collagen-induced thromboxane A2 (TXA2) production in rat platelets. In addition, oral administration of LLE was protective in a mouse model of pulmonary thromboembolism induced by intravenous injection of a mixture of collagen and epinephrine. Interestingly, LLE did not significantly alter prothrombin time (PT) and activated partial thromboplastin time (aPTT). This study indicates that the antithrombotic effects of LLE might be due to its antiplatelet activities rather than anticoagulation. Taken together, these results suggest that LLE may be a candidate preventive and therapeutic agent in cardiovascular diseases associated with platelet hyperactivity.

• Journal of Chest Surgery
• /
• v.22 no.1
• /
• pp.106-115
• /
• 1989

Clinical results with the xenograft cardiac valves were reviewed for 212 patients who underwent heart valve replacement from January 1981 to December 1987. One hundred and twenty-four Carpentier-Edwards k 88 Ionescu Shiley valves were used. Overall operative mortality was 11 out of 212[5.1%]: 5 out of 153[3.39o] for mitral valve replacement [MVR], 2 out of 34[5.9%] for aortic valve replacement [AVR], 0 out of 4[0%] for Tricuspid valve replacement [TVR], and 4 out of 21[19.1%] for double valve replacement [DVR;MVR+ AVR]. Two hundred and one operative survivors were followed up for a total of 824.3 patient-years [a mean 3.9*1.8 yrs], and the follow up was 78.1%. The linealized complication rates were 0.1% emboli / patient-year, 1.0% endocarditis/ patient-year and 2.2% overall valve failure / patient-year. A linealized rate of primary tissue failure was 0.7*/o/ patient-year. The actuarial survival rates including the operative mortality were 92*2.8% at 4 years and 85*4.3% at 7 years after surgery using the Xenograft cardiac valves. Probabilities of freedom from thromboembolism and overall valve failure were 73*11.0% and 69*2.4% at 7 years after surgery using the Xenograft cardiac valves respectively. The intrinsic durability of the Xenograft cardiac valves appears to be relatively well satisfactory over the long term [4 to 7 years] and the risk of failure appears well balanced by the advantages of a low incidence of thromboembolism and no mandatory anticoagulant therapy.

• Journal of Yeungnam Medical Science
• /
• v.31 no.1
• /
• pp.28-32
• /
• 2014

Pulmonary thromboembolism (PTE) increases the pressure of the right ventricle and leads to symptoms and signs, such as dyspnea and hypoxia. If PTE causes hemodynamic instability, thrombolytic therapy should be considered. A mechanical thrombectomy is an alternative treatment to thrombolytic therapy and should be considered when thrombolytic therapy is contraindicated. Various devices are used in mechanical maceration and catheter-directed thrombolysis, but there is no standard mechanical device for PTE as yet. We report here on 2 clinical experiences of mechanical thrombectomy using the Arrow-Trerotola percutaneous thrombolytic device to remove residual clots after systemic thrombolysis in patients with massive PTE.