Pulmonary thromboembolism

Abstract

To improve the available techniques, diagnostic and therapeutical policies were analyzed in patients with angiographically documented pulmonary thromboembolism (PTE). The investigation included 151 patients with suspected PTE. Angiopulmonography from the pulmonary trunk and great branches provided data on the pulmonary vessels. The diagnosis of PTE was verified in 138 patients: acute massive and submassive types in 44 patients, mild and chronic PTE in 22 and 72 patients, respectively. Fibrinolytic therapy was performed in 34 patients with acute PTE, the others were treated with heparin. In the massive and submassive PTE group, the Miller index was 23.7 +/- 0.86 scores, pulmonary systolic pressure was 56.2 +/- 2.7 mm Hg. The mortality rates were 29.5%, the Miller residual index was 9.9 +/- 1.1 scores. In the mild PTE group, the Miller index averaged 5.2 +/- 0.88 scores, pulmonary pressure was in the upper normal range. All patients with this type recovered after treatment, the residual index was 1.4 +/- 0.5 scores. Fibrinolysis is the method of choice in the treatment of massive pulmonary embolism: however, the administration of large-dose heparin may be rather effective. Heparin therapy ensures blood flow recovery in mild PTE. The severity of pulmonary circulatory and hemodynamic disorders and the time of therapy initiation determine the efficiency of treatment in acute PTE.