Pulmonary embolism(PE)ranks as the third leading cause of cardiovascularrelated deaths in Western nations.Patients classified as high-risk(HR)-those exhibiting hemodynamic instability-require immediate interventions t...Pulmonary embolism(PE)ranks as the third leading cause of cardiovascularrelated deaths in Western nations.Patients classified as high-risk(HR)-those exhibiting hemodynamic instability-require immediate interventions to restore blood flow.While intermediate–HR(IHR)individuals remain hemodynamically stable,they face a significant chance of clinical decline and thus need close and continuous observation.Effective risk assessment,mortality prediction,and therapeutic decision-making in these patients rely on a combination of clinical evaluation and imaging studies.Catheter-directed therapy(CDT)has emerged as a promising option,offering the ability to alleviate clot burden and reduce strain on the right ventricle,all while posing a lower risk of major bleeding compared to systemic thrombolysis.The growing adoption of CDT reflects its increasing relevance in PE treatment,especially when managed by specialized PE response teams that ensure individualized,multidisciplinary care.As clinical practices evolve,further studies and robust clinical trials are necessary to clearly define CDT’s role in lowering the risks of complications and death among IHR PE patients.This article explores the current understanding and future direction of managing PE,focusing in the role of catheter-based interventions.展开更多
A 73-year-old female presented with symp-tomatic heart failure(NYHA class Ⅲ)due to a failed 29-mm Sorin(St.Jude Medical,St.Paul,MN)bioprosthetic heart valve surgically implanted 10-year before for severe primary mitr...A 73-year-old female presented with symp-tomatic heart failure(NYHA class Ⅲ)due to a failed 29-mm Sorin(St.Jude Medical,St.Paul,MN)bioprosthetic heart valve surgically implanted 10-year before for severe primary mitral valve regurgitation(flail of the anterior mitral leaf-let at A2 scallop).Preprocedural echocardiography showed preserved left ventricular function with severe bioprosthetic valve stenosis and concomit-ant moderate regurgitation(Video 1 in Supplement).Because of prohibitive surgical risk,a transeptal mitral valve-in-valve(ViV)replacement was planned.展开更多
文摘Pulmonary embolism(PE)ranks as the third leading cause of cardiovascularrelated deaths in Western nations.Patients classified as high-risk(HR)-those exhibiting hemodynamic instability-require immediate interventions to restore blood flow.While intermediate–HR(IHR)individuals remain hemodynamically stable,they face a significant chance of clinical decline and thus need close and continuous observation.Effective risk assessment,mortality prediction,and therapeutic decision-making in these patients rely on a combination of clinical evaluation and imaging studies.Catheter-directed therapy(CDT)has emerged as a promising option,offering the ability to alleviate clot burden and reduce strain on the right ventricle,all while posing a lower risk of major bleeding compared to systemic thrombolysis.The growing adoption of CDT reflects its increasing relevance in PE treatment,especially when managed by specialized PE response teams that ensure individualized,multidisciplinary care.As clinical practices evolve,further studies and robust clinical trials are necessary to clearly define CDT’s role in lowering the risks of complications and death among IHR PE patients.This article explores the current understanding and future direction of managing PE,focusing in the role of catheter-based interventions.
文摘A 73-year-old female presented with symp-tomatic heart failure(NYHA class Ⅲ)due to a failed 29-mm Sorin(St.Jude Medical,St.Paul,MN)bioprosthetic heart valve surgically implanted 10-year before for severe primary mitral valve regurgitation(flail of the anterior mitral leaf-let at A2 scallop).Preprocedural echocardiography showed preserved left ventricular function with severe bioprosthetic valve stenosis and concomit-ant moderate regurgitation(Video 1 in Supplement).Because of prohibitive surgical risk,a transeptal mitral valve-in-valve(ViV)replacement was planned.
