Surgical management of XXXX .

@entity1 @entity712 @entity548 @entity28 @entity120 @entity2268 @entity1151 @entity338 @entity519 @entity358 @entity1576 @entity432 @entity67 @entity204
Recurrent @entity1151 ultimately may produce @entity1576 , severe @entity519 , and @entity120 . In many @entity1 this syndrome is silent in its initial phases, and when @entity2268 is present it is often unresponsive to anticoagulant therapy. Unless @entity358 is undertaken, most of these @entity1 characteristically succumb with severe @entity1576 . Twenty-five @entity1 with this syndrome have been evaluated at the Duke University Medical Center, and 14 were selected for elective @entity358 for relief of severe and incapacitating @entity338 . In each @entity1 preoperative pulmonary scans and arteriography demonstrated a high degree of @entity432 . The obstructing lesions affected both lungs in the majority of @entity1 . Bronchial arteriography was found to be a very valuable method for demonstrating patency of the pulmonary arteries distal to occluding lesions by retrograde filling through collateral vessels joining the bronchial and pulmonary circulations. Preoperatively radionuclide angiocardiography revealed severe right @entity67 with significantly depressed ejection fractions at rest and during exercise. Retrograde pulmonary arterial flow as shown by selective bronchial arteriography was excellent in ten @entity1 , fair in three, and absent in one. Long term follow-up indicated a clear relationship between the magnitude of arterial backflow at the time of embolectomy and the degree of clinical improvement. There were two perioperative @entity204 , one from massive reperfusion @entity548 and another from intractable @entity67 . Eleven @entity1 with this syndrome were unsuitable candidates for embolectomy and of these, nine had severe distal emboli diffusely spread in the small pulmonary arteries and not amenable to direct removal. One @entity1 had severe @entity67 with @entity120 (145/45 mmHg) and another was @entity28 with severe @entity712 and expired in the hospital a week later. In this group of 11 @entity1 , three succumbed and most of the others are currently totally debilitated at rest (NYHA Class IV). Long-term follow-up of the surgically managed @entity1 (1 to 15 years) shows that ten @entity1 improved from NYHA functional Class IV to either I or II, another @entity1 from Class III to Class I, and a final @entity1 was only minimally improved.(ABSTRACT TRUNCATED AT 400 WORDS)
