KMA‐Greenfield® Filter Placement for Chronic Pulmonary Hypertension
KMA‐Greenfield® Filter Placement for Chronic Pulmonary Hypertension
复制标题
KMA‐Greenfield® 过滤器放置治疗慢性肺动脉高压
作者：
L. Greenfield;L. Scher;R. Elkins
在四年的时间里，23例患者根据静息肺动脉压平均值高于30 mmHg诊断为慢性肺动脉高压。临床特征包括呼吸困难（100%）、既往血栓栓塞（43%）、充血性衰竭（39%）、静脉血栓形成（35%）、晕厥（30%）、肺部疾病（22%）、近期创伤（22%）、咯血（17%）和心前区疼痛（17%）。肺动脉造影显示栓塞闭塞，但4例患者被认为有原发性肺动脉高压。18名患者植入了KimRay-Greenfield®腔静脉滤器。其中三人当时处于难治性休克状态，只有一人成功进行了腔内导管取栓术。这些患者平均随访23个月，有2例栓塞性死亡，1例来自右心房，1例绕过了错误放置在右髂静脉中的滤器（总死亡率22%）。没有其他已知的复发性栓塞，但有1例患者因滤器发生血尿。未接受滤器的5名患者均在间隔长达18个月后死亡。3例患者记录了复发性血栓栓塞，1例疑似栓塞性疾病患者突然死亡。无论病因如何，肺源性心脏病合并肺动脉高压与致死性血栓栓塞的高发生率相关。根据我们的经验，长期抗凝治疗和放置腔静脉滤器可提供最大保护。
Over a period of four years, 23 patients had the diagnosis of chronic pulmonary hypertension made on the basis of elevated resting pulmonary arterial pressures above 30 mmHg mean. Clinical features included dyspnea (100%), previous thromboembolism (43%), congestive failure (39%), venous thrombosis (35%), syncope (30%), lung disease (22%), recent trauma (22%), hemoptysis (17%) and precordial pain (17%). Pulmonary angiograms showed embolic occlusion in all hut four patients, who were considered to have primary pulmonary hypertension. KimRay-Greenfield® vena caval filters were inserted in 18 patients. Three of them were in refractory shock at the time, and only the one who had successful intraluminal catheter embolectomy survived. These patients have been followed an average of 23 months with two embolic deaths, one from the right atrium and one bypassing a filter misplaced in the right iliac vein (overall mortality 22%). There has been no other known recurrent embolism, but one patient developed hematuria from the filter. The five patients who did not receive a filter have all died after intervals up to 18 months. Recurrent thromboembolism was documented in three and suspected in one patient with known embolic disease who died suddenly. Regardless of etiologic factors, pulmonary hypertension with cor pulmonale is associated with a high incidence of fatal thromboembolism. In our experience, maximal protection is afforded by long-term anticoagulation therapy and the placement of a venacaval filter.