Фатальна тромбоемболія легеневої артерії: клініко-патоморфологічна характеристика: автореферат PhD дисертації [Fatal pulmonary thromboembolism: clinical and pathomorphological characteristics. Extended abstract of PhD dissertation] (Ukrainian) (original) (raw)

The PhD dissertation studies the clinical-pathomorphological features of fatal pulmonary artery thromboembolism (PTE). Based on retrospective and prospective analysis, the results of 333 autopsies of patients who died from PTE at the Lviv Regional Clinical Hospital over 18 years (1990-2007) were examined. A comprehensive analysis of clinical data, hemostasiological indicators, and autopsy protocols was conducted. The factors and degrees of risk, sources, diseases, and surgical interventions complicated by fatal PTE were identified. The frequency of PTE ranged from 3.7% to 9.3% (an average of 6.7% among 4,986 autopsies) and showed no tendency to decrease. Depending on the location and conditions of the development of venous thromboembolism, all cases of fatal PTE were divided into three groups: 1. Hospital-acquired PTE, which developed in the hospital – 241 cases (72.4% of the total observations). 2. Community-acquired PTE, which occurred in out-of-hospital conditions – 84 cases (25.2%). 3. PTE developed in other medical institutions and was the reason for transferring patients to the Clinical Hospital, with 8 patients (2.4%). Risk factors for fatal PTE were established in 96.4% of patients. The main risk factors for PTE were age over 60 years, surgeries, and heart failure. The overwhelming majority of hospitalized patients (84.6%) had a high risk of developing PTE. Hospital-acquired PTE often complicates the course of diseases of the digestive organs (27.8%), malignant neoplasms (24.5%), diseases of the circulatory system (19.1%), and the genitourinary system (13.3%). In operated patients, PTE occurred predominantly in the first week, most typically after surgeries on the abdominal organs, pelvis, and genitals. The clinic-morphological forms of fatal PTE were: 1. Single (59.8%). 2. Recurrent (36.0%). 3. Recurrent with the development of chronic precapillary pulmonary hypertension (4.2%). The study results indicated a low level of clinical diagnosis of PTE. Hospital-acquired venous thromboembolism was diagnosed in only 10.0% of patients. In most cases, PTE was identified in the final clinical diagnosis due to sudden death upon completion of the medical history for autopsy. Pathomorphological Manifestations: The main pathomorphological manifestations of single PTE were “fresh” thromboemboli in the pulmonary artery system. In recurrent PTE, thromboemboli of varying duration and lung infarctions were observed. In patients with recurrent PTE and chronic precapillary pulmonary hypertension, organized and recanalized thromboemboli with the formation of two- and multi-stem structures, intravascular fibrous septa, eccentric fibrosis, and eccentric intimal plaques were found. Additionally, medial hypertrophy, obliteration of small branch lumens, lipomatosis of the intima of elastic-type pulmonary arteries, and right ventricular myocardium hypertrophy were noted. Sources of PTE: The sources of PTE were identified at autopsy in 58.6% of deceased patients. Among them, deep vein thromboses of the lower extremities predominated (68.2%). Less frequently, thromboses of the right heart chambers (12.3%) and pelvic veins (8.2%) were found. In 16.5% of cases, the source of fatal PTE was thromboses resulting from medical manipulations on the main veins. Clinical Defects and Recommendations: Based on autopsy analysis, clinical diagnostic and preventive defects of PTE in a multidisciplinary hospital were studied. The main clinical defects were the absence of a hemostasiological history, assessment of factors and degrees of risk, adequate hemostasiological examination and monitoring of the hemostatic system state, and a low level of nonspecific prevention and pharmacoprophylaxis. Recommendations for the prevention of hospital-acquired PTE were justified. A protocol for expert assessment of the quality of diagnostic and therapeutic measures aimed at preventing PTE in a multidisciplinary medical institution was developed.