Treatment Of Massive Pulmonary Embolism Research Articles

Local fibrinolysis for the treatment of massive pulmonary embolism: Efficacy of streptokinase infusion through pulmonary arterial catheter

Local fibrinolysis for the treatment of massive pulmonary embolism: Efficacy of streptokinase infusion through pulmonary arterial catheter

Sustained improvement of pulmonary hemodynamics in patients at rest and during exercise after thrombolytic treatment of massive pulmonary embolism.

This study assessed the long-term effects of thrombolytic treatment in patients with acute massive pulmonary embolism (PE). Seven patients with PE that followed deep-vein thrombosis underwent pulmonary angiography and pressure measurements before and 6 +/- 3 days (mean +/- SD) and 15 +/- 4 months after treatment with intrapulmonary infusions of urokinase (average dose 1724 U/kg X hr) and heparin (average dose 17 U/kg X hr). Treatment was guided by daily measurements of pulmonary arterial (PA) pressure and was continued until PA pressure had normalized (average of 6 days). Late after treatment patients returned for pulmonary angiographic examination, right heart catheterization at rest and during bicycle exercise, and phlebography of the deep veins of both legs. Pulmonary angiograms showed massive obstruction before therapy (Walsh index 15 +/- 2 points of a maximum of 18 points), which was improved 6 days (3 +/- 3 points) and 15 months (1 +/- 2 points) after therapy. Mean PA pressure declined from 37 +/- 9 to 13 +/- 3 mm Hg after 6 days and to 15 +/- 3 mm Hg after 15 months. No recurrence of PE was observed. In six of seven patients at rest and during bicycle exercise (up to 100 W) in the supine position mean PA pressure and total pulmonary resistance remained within normal limits. Over the short term all patients showed clinical signs of deep-vein thrombosis; 15 months later four patients had normal deep veins, but three patients had still phlebographic signs of old thrombosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Pulmonary thromboembolism

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.

Surgical treatment of massive pulmonary embolism. (Reported of 45 successful embolectomies inclusive 10 with Trendelenburg's technic) (author's transl)

45 pulmonary embolectomies have been carried out successfully, 10 by Trendelenburg's procedure, 35 with extracorporeal circulation. The latter method gives satisfactory results (34 survivals out of 36 attempts since 1970) and appears to be the procedure of choice. Any pulmonary trauma should be avoided at operation; embolectomy is done by intra-vascular suction. The hemodynamic status was always abnormal: 5 initial cardiac arrests, 20 cases of severe shock (9 demonstrating cardiac arrest on the operating table) and 11 cases with less severe shock. In 9 cases cyanosis, respiratory distress and signs of acute cor pulmonale were the clinical features of the massive embolus. In 9 patients the operation was performed after an unsuccessful trial of thrombolysis. Preoperative pulmonary angiography could be performed in 30 cases and always showed extensive pulmonary vascular obstruction of 60 to 95 per cent. These data are important for diagnosis and for assessment of the prognosis. Despite of present medical treatment with fibrinolytics, surgery is still advisable in the treatment of massive pulmonary embolism. The indications are moribund patients, those in whom thrombolysis is contraindicated or unsuccessful and those with massive pulmonary obstruction (greater than 60 per cent). In this latter subset thrombolytic therapy carries a high level of mortality.

Treatment of Massive Pulmonary Embolism

Treatment of Massive Pulmonary Embolism

Treatment of massive pulmonary embolism: the role of pulmonary embolectomy

Treatment of massive pulmonary embolism: the role of pulmonary embolectomy

Treatment of massive pulmonary embolism.

Treatment of massive pulmonary embolism.

Treatment of massive pulmonary embolism with pulmonary artery aspiration employing cardiopulmonary bypass: An experimental study

Treatment of massive pulmonary embolism with pulmonary artery aspiration employing cardiopulmonary bypass: An experimental study

Treatment of massive pulmonary embolism with pulmonary artery aspiration employing partial cardiopulmonary bypass

Treatment of massive pulmonary embolism with pulmonary artery aspiration employing partial cardiopulmonary bypass

Total circulatory support in the treatment of massive pulmonary embolism.

Total circulatory support in the treatment of massive pulmonary embolism.

Conservative Treatment of Massive Pulmonary Embolism

SPONTANEOUS resolution of massive pulmonary embolism has been reported. 1 Important questions, however, remain to be answered. Do these emboli produce a permanent change in pulmonary function and pulmonary vascular resistance? Is pulmonary embolectomy ever indicated except as a life-saving procedure? What procedures are necessary to prevent further embolization? How rapidly does resolution of. the emboli take place? It is apparent that a large body of information is a necessity before these problems can be solved. In the case to be reported the large emboli present in the main pulmonary artery and its right and left branches resolved spontaneously. Four pulmonary angiograms were performed providing adequate roentgen demonstration of the emboli and their resolution. Subsequent pulmonary-function studies failed to reveal any adverse effect of the massive emboli. Report of a Case A 40-year-old white man suffered a fracture of his left tibia and fibula on Nov 9, 1964. Seven days

Conservative treatment of massive pulmonary embolism

Conservative treatment of massive pulmonary embolism