Thrombotic Lesion of the Pulmonary Vessels in Patients with Pulmonary Embolism
After suffering pulmonary embolism (PE), doctors are confronted with various consequences of the disease, from asymptomatic residual pulmonary thrombosis to the formation of chronic thromboembolic pulmonary hypertension (CTEPH). There is also a subgroup of patients who have undergone pulmonary embol...
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| Format: | Article |
| Language: | English |
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Столичная издательская компания
2020-12-01
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| Series: | Рациональная фармакотерапия в кардиологии |
| Subjects: | |
| Online Access: | https://www.rpcardio.online/jour/article/view/2360 |
| _version_ | 1826949570902360064 |
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| author | A. A. Klimenko N. A. Demidova N. A. Shostak M. O. Anischenko |
| author_facet | A. A. Klimenko N. A. Demidova N. A. Shostak M. O. Anischenko |
| author_sort | A. A. Klimenko |
| collection | DOAJ |
| description | After suffering pulmonary embolism (PE), doctors are confronted with various consequences of the disease, from asymptomatic residual pulmonary thrombosis to the formation of chronic thromboembolic pulmonary hypertension (CTEPH). There is also a subgroup of patients who have undergone pulmonary embolism, who experience shortness of breath during physical exertion, absent before pulmonary embolism, or shortened dyspnea preceding PE, combined with residual thrombosis of pulmonary artery (PA) and normal average pressure in PA at rest during catheterization of the right heart (CRH). This condition is defined as chronic thromboembolic pulmonary disease or post thromboembolic syndrome. Pathogenetic aspects of this condition are not fully investigated. It is important to predict the development of postembolic syndrome and to develop algorithms for the diagnosis, treatment and rehabilitation of patients with symptoms and residual pulmonary thrombosis. In case of the development of pulmonary vasculopathy in some patients who have undergone pulmonary embolism, a severe life-threatening condition forms - CTEPH, characterized by an increase in pressure in the pulmonary artery, right heart failure due to the presence of organized blood clots that have entered the pulmonary vascular bed during PE. The volume of thrombotic masses does not always correlate with clinical symptoms, which indicates the importance of microvascular remodeling. If CTEPH is suspected, a diagnostic algorithm is required, including ventilation-perfusion scintigraphy, CT angiopulmonography and catheterization of the right heart. Treating a patient with CTEPH is a difficult task fora doctor. The timely referral of the patient to the center where they are involved in treatment, including surgery and CTEPH is extremely important. Timely performed thrombendarterectomy in some cases allows to completely cure the patient. In the case of inoperable CTEPH or residual pulmonary hypertension after thrombendarterectomy, balloon angioplasty of the PA is used as well as drug treatment with specific drugs that reduce the pressure in the PA (riociguat), endothelin receptor antagonists (bosentan, macitentan), prostanoids (inhalant illoprost) phosphodiesterase-5 inhibitor and combined therapy. In this article we considered some consequences directly related to PE: asymptomatic residual pulmonary thrombosis, chronic thromboembolic pulmonary disease, chronic thromboembolic pulmonary hypertension. |
| first_indexed | 2024-03-08T14:00:54Z |
| format | Article |
| id | doaj.art-37ae0ea1e80242c7979c07a54aa2300c |
| institution | Directory Open Access Journal |
| issn | 1819-6446 2225-3653 |
| language | English |
| last_indexed | 2025-02-17T22:16:15Z |
| publishDate | 2020-12-01 |
| publisher | Столичная издательская компания |
| record_format | Article |
| series | Рациональная фармакотерапия в кардиологии |
| spelling | doaj.art-37ae0ea1e80242c7979c07a54aa2300c2024-12-04T11:48:19ZengСтоличная издательская компанияРациональная фармакотерапия в кардиологии1819-64462225-36532020-12-011661002100810.20996/1819-6446-2020-12-091831Thrombotic Lesion of the Pulmonary Vessels in Patients with Pulmonary EmbolismA. A. Klimenko0N. A. Demidova1N. A. Shostak2M. O. Anischenko3Pirogov Russian National Research Medical UniversityPirogov Russian National Research Medical UniversityPirogov Russian National Research Medical UniversityPirogov Russian National Research Medical UniversityAfter suffering pulmonary embolism (PE), doctors are confronted with various consequences of the disease, from asymptomatic residual pulmonary thrombosis to the formation of chronic thromboembolic pulmonary hypertension (CTEPH). There is also a subgroup of patients who have undergone pulmonary embolism, who experience shortness of breath during physical exertion, absent before pulmonary embolism, or shortened dyspnea preceding PE, combined with residual thrombosis of pulmonary artery (PA) and normal average pressure in PA at rest during catheterization of the right heart (CRH). This condition is defined as chronic thromboembolic pulmonary disease or post thromboembolic syndrome. Pathogenetic aspects of this condition are not fully investigated. It is important to predict the development of postembolic syndrome and to develop algorithms for the diagnosis, treatment and rehabilitation of patients with symptoms and residual pulmonary thrombosis. In case of the development of pulmonary vasculopathy in some patients who have undergone pulmonary embolism, a severe life-threatening condition forms - CTEPH, characterized by an increase in pressure in the pulmonary artery, right heart failure due to the presence of organized blood clots that have entered the pulmonary vascular bed during PE. The volume of thrombotic masses does not always correlate with clinical symptoms, which indicates the importance of microvascular remodeling. If CTEPH is suspected, a diagnostic algorithm is required, including ventilation-perfusion scintigraphy, CT angiopulmonography and catheterization of the right heart. Treating a patient with CTEPH is a difficult task fora doctor. The timely referral of the patient to the center where they are involved in treatment, including surgery and CTEPH is extremely important. Timely performed thrombendarterectomy in some cases allows to completely cure the patient. In the case of inoperable CTEPH or residual pulmonary hypertension after thrombendarterectomy, balloon angioplasty of the PA is used as well as drug treatment with specific drugs that reduce the pressure in the PA (riociguat), endothelin receptor antagonists (bosentan, macitentan), prostanoids (inhalant illoprost) phosphodiesterase-5 inhibitor and combined therapy. In this article we considered some consequences directly related to PE: asymptomatic residual pulmonary thrombosis, chronic thromboembolic pulmonary disease, chronic thromboembolic pulmonary hypertension.https://www.rpcardio.online/jour/article/view/2360acute pulmonary embolismpulmonary embolismchronic thromboembolic pulmonary hypertensionpost-thromboembolic syndromechronic thromboembolic pulmonary diseaseresidual pulmonary thrombosiscardiorespiratory testrehabilitation |
| spellingShingle | A. A. Klimenko N. A. Demidova N. A. Shostak M. O. Anischenko Thrombotic Lesion of the Pulmonary Vessels in Patients with Pulmonary Embolism Рациональная фармакотерапия в кардиологии acute pulmonary embolism pulmonary embolism chronic thromboembolic pulmonary hypertension post-thromboembolic syndrome chronic thromboembolic pulmonary disease residual pulmonary thrombosis cardiorespiratory test rehabilitation |
| title | Thrombotic Lesion of the Pulmonary Vessels in Patients with Pulmonary Embolism |
| title_full | Thrombotic Lesion of the Pulmonary Vessels in Patients with Pulmonary Embolism |
| title_fullStr | Thrombotic Lesion of the Pulmonary Vessels in Patients with Pulmonary Embolism |
| title_full_unstemmed | Thrombotic Lesion of the Pulmonary Vessels in Patients with Pulmonary Embolism |
| title_short | Thrombotic Lesion of the Pulmonary Vessels in Patients with Pulmonary Embolism |
| title_sort | thrombotic lesion of the pulmonary vessels in patients with pulmonary embolism |
| topic | acute pulmonary embolism pulmonary embolism chronic thromboembolic pulmonary hypertension post-thromboembolic syndrome chronic thromboembolic pulmonary disease residual pulmonary thrombosis cardiorespiratory test rehabilitation |
| url | https://www.rpcardio.online/jour/article/view/2360 |
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