Chronic persistent pulmonary embolism. Report of three cases.
Nonresolution of acute pulmonary embolism and resultant chronic persistent pulmonary occlusion is uncommon; documentation of its occurrence in patients receiving anticoagulants is sparse. We report three cases with hemodynamic data and follow-up of up to seven years. All patients had mild to moderate dyspnea on exertion. All patients had normal resting pulmonary artery pressures; two patients demonstrated pulmonary hypertension with exercise. One patient underwent successful thromboendarterectomy but had subsequent reocclusion secondary to in situ thrombosis. With all patients receiving long-term anticoagulant therapy, there was no clinical recurrence of embolization or progression of symptoms. Patients with chronic persistent pulmonary embolism should be identified and should receive long-term follow-up. Therapy aimed at prevention of recurrent embolization is required. Pulmonary thromboendarterectomy is indicated for selected patients.
D000328:Adult; D001794:Blood Pressure; D002908:Chronic Disease; D004691:Endarterectomy; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007275:Injections, Intravenous; D007279:Injections, Subcutaneous; D008875:Middle Aged; D011247:Pregnancy; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery; D011655:Pulmonary Embolism / Q000628:therapy*; D013997:Time Factors; D014655:Vascular Resistance; D014859:Warfarin / Q000008:administration & dosage
D014859:Warfarin; D006493:Heparin