PMID- 9752552
OWN - NLM
STAT- MEDLINE
DCOM- 19981116
LR  - 20191102
IS  - 0001-4001 (Print)
IS  - 0001-4001 (Linking)
VI  - 123
IP  - 1
DP  - 1998 Feb
TI  - [Pulmonary thromboendarterectomy with video-angioscopy and circulatory arrest: an 
      alternative to cardiopulmonary transplantation and post-embolism pulmonary artery 
      hypertension].
PG  - 32-40
AB  - The best predictor of poor or suboptimum outcome from pulmonary 
      thromboendarterectomy (PTE) is insufficient relief of obstruction, especially in 
      the lower lobes. The aim of this study is to emphasize that the use of 
      video-assisted angioscopy may increase the quality of PTE and thus improve 
      outcome. PTE included a median sternotomy, intrapericardial dissection limited to 
      the superior vena cava, institution of cardiopulmonary bypass, deep hypothermia 
      and sequential circulatory arrest periods. PTE was always bilateral and performed 
      through two separate arteriotomies of both main intrapericardial pulmonary 
      arteries. A rigid 5 mm angioscope connected to a video camera was introduced 
      through the arteriotomy into the lumen to increase the visibility and perform the 
      video-assisted endarterectomies of all obstructed segmental branches, including 
      normally inaccessible anterior segmental branches. Between January 1996 and 
      December 1997, 48 patients with severe postembolic pulmonary hypertension had 
      PTE. Patients were in New York Heart Association (NYHA) class II (n = 2), III (n 
      = 28) or IV (n = 18) with the following hemodynamics: mean pulmonary arterial 
      pressure (PAP) 53 +/- 13 mmHg, cardiac index 2.16 +/- 0.5 L/min/m2, pulmonary 
      vascular resistances (PVR): 1,152 +/- 414 dyne.s-1.cm-5. Six patients died from 
      alveolar hemorrhage (n = 1), high residual pulmonary pressure and rethrombosis (n 
      = 4) and hypoxic cardiac arrest (n = 1). The functional outcome in surviving 
      patients was as follows: (NYHA) class I (n = 24), II (n = 16) or III (n = 2) with 
      improved hemodynamics: mean pulmonary arterial pressure: 30 +/- 9 mmHg, cardiac 
      index: 2.78 +/- 0.5 L/min/m2, pulmonary vascular resistances (PVR): 484 +/- 159 
      dynes.s-1.cm-5. Video-assisted angioscopy allows much improved quality and degree 
      of pulmonary endarterectomy. This expands the indications to include patients 
      with previously inaccessible distal disease and candidates for heart-lung 
      transplantation.
FAU - Dartevelle, P
AU  - Dartevelle P
AD  - Service de chirurgie thoracique vasculaire et de transplantation 
      cardiopulmonaire, hopital Marie-Lannelongue, Le Plessis-Robinson, France.
FAU - Fadel, E
AU  - Fadel E
FAU - Chapelier, A
AU  - Chapelier A
FAU - Macchiarini, P
AU  - Macchiarini P
FAU - Cerrina, J
AU  - Cerrina J
FAU - Leroy-Ladurie, F
AU  - Leroy-Ladurie F
FAU - Parquin, F
AU  - Parquin F
FAU - Simonneau, F
AU  - Simonneau F
FAU - Parent, F
AU  - Parent F
FAU - Humbert, M
AU  - Humbert M
FAU - Simonneau, G
AU  - Simonneau G
LA  - fre
PT  - English Abstract
PT  - Journal Article
TT  - Thrombo-endarteriectomie pulmonaire sous video-angioscopie et arret circulatoire: 
      une alternative a la transplantation cardiopulmonaire dans l'hypertension 
      arterielle pulmonaire postembolique.
PL  - France
TA  - Chirurgie
JT  - Chirurgie; memoires de l'Academie de chirurgie
JID - 0236600
SB  - IM
MH  - Adult
MH  - Aged
MH  - *Angioscopes
MH  - Endarterectomy/*instrumentation
MH  - Female
MH  - Heart Arrest, Induced
MH  - *Heart-Lung Transplantation
MH  - Humans
MH  - Hypertension, Pulmonary/etiology/mortality/*surgery
MH  - Male
MH  - Middle Aged
MH  - Pulmonary Embolism/etiology/mortality/*surgery
MH  - Surgical Equipment
MH  - Survival Rate
MH  - Video Recording/*instrumentation
EDAT- 1998/09/30 00:00
MHDA- 1998/09/30 00:01
CRDT- 1998/09/30 00:00
PHST- 1998/09/30 00:00 [pubmed]
PHST- 1998/09/30 00:01 [medline]
PHST- 1998/09/30 00:00 [entrez]
AID - S0001400198800366 [pii]
AID - 10.1016/s0001-4001(98)80036-6 [doi]
PST - ppublish
SO  - Chirurgie. 1998 Feb;123(1):32-40. doi: 10.1016/s0001-4001(98)80036-6.