surgery in pulmonary embolisms

Conditions: Pulmonary Embolism

Summary: measure early out comes of surgical pulmonary embolectomy in patients with massive and sub massive pulmonary embolism.

* pulmonary embolism (pe) is one of the most important causes of mortality in cardiovascular diseases. it represents the third cause of mortality after myocardial infarction and stroke. * risk factors of pulmonary embolism include malignancy, recent operation, hypercoagulability, and deep venous thrombosis (dvt). dvt is the most common risk factor. * acute pulmonary embolism is classified into massive or high risk (characterized by evidence of low-cardiac-output syndrome or clinical shock attributed to pe as the underlying cause, based on 1 or more of the following: systemic arterial systolic blood pressure\<90 mm hg, need for positive inotrope or systemic vasoconstrictor support, need for mechanical circulatory support, cardiac arrest, or profound bradycardia (heart rate\<40 bpm)) and sub massive type or intermediate-high risk (characterized by evidence of adverse effects on the rv (dysfunction and strain), with mild hypotension, tachycardia, and 1 or more of the following: rv systolic hypo kinesis, rv dilatation by echocardiogram , elevated cardiac biomarkers (troponin i), elevated serum n-terminal pro brain natriuretic peptide, or electrocardiogram changes suggestive of rv strain.). * treatment options of acute massive and sub massive pe include systemic thrombolytic therapy, catheter directed thrombolysis (cdt) and surgical pulmonary embolectomy (sbe). * the outcomes of the surgical treatment to the catheter-based treatment is still a topic of interest in management of acute pulmonary embolism. * this study aims to measure early out comes of surgical pulmonary embolectomy in patients with massive and sub massive pulmonary embolism.

Eligibility criteria:
inclusion criteria: * patient with massive pulmonary embolism or high-risk patients characterized by : * evidence of low-cardiac-output syndrome or clinical shock attributed to pe as the underlying cause, based on 1 or more of the following: systemic arterial systolic blood pressure\<90 mm hg, need for positive inotrope or systemic vasoconstrictor support, need for mechanical circulatory support, cardiac arrest, or profound bradycardia (heart rate\<40 bpm). * ct pulmonary angiography demonstrating a thrombus which occludes greater than 50% of the pulmonary artery (pa) cross-sectional area or occludes two or more lobar arteries. * echocardiography both trans thoracic and trans esophageal shows right ventricular (rv) systolic dysfunction, rv dilation, or a rv/left ventricular (lv) diameter ratio of \>0.9 on four chamber view. * elevated cardiac troponin t and i above normal limits. patients with sub massive pulmonary embolism or intermediate -high risk characterized by: * systolic blood pressure \>90 mmhg and tachycardia (heart rate \> 100 bpm). * ct pulmonary angiography shows that 30% to 50% of the pulmonary vasculature is occluded. * echocardiography both trans thoracic and trans esophageal shows right ventricular (rv) systolic dysfunction, rv dilation, or a rv/left ventricular (lv) diameter ratio of \>0.9 on four chamber view. * elevated cardiac troponin t and i above normal limits exclusion criteria: * patients less than 18 years of age. * low risk acute pulmonary embolism (less than 30% occlusion of pulmonary vasculature by ct pulmonary angiography, no signs of rt ventricular systolic dysfunction, rv dilation or a rv/left ventricular (lv) diameter ratio of \>0.9 on four chamber view by echocardiography. * acute on top of chronic pulmonary embolism.