Mechanical fragmentation and intrapulmonary fibrinolysis in the treatment of massive pulmonary embolism hemodynamic repercussions

OBJECTIVE: To evaluate the efficacy and safety of mechanical fragmentation associated with intrapulmonary thrombolysis to treat massive pulmonary thro mboembolism (PTE) with altered hemodynamics. MATERIAL AND METHOD: Fifty-one patients with a diagnosis of acute PTE were enrolled, the criteria being a Miller index over 0.50 and mean pressure of 30 mmHg in the principal superior pulmonary artery. The initial clinical pi ctures included shock (19 patients), syncope (6) and severe dyspnea at rest (26). Oxygen saturation measured by pulse oxymetry was 71.4%. Mean pulmona ry artery pressure was 46.1 mmHg. The main thromboembolisms were fragmented , with one bolus of a fibrinolytic agent administered during the fragmentat ion procedure. An infusion of the fibrinolytic agent was administered throu gh a catheter. Monitoring included clinical assessment, pulmonary scintigra phy and echocardiography. RESULTS: After fragmentation and administration of the bolus dose of the fi brinolytic agent, improvement was observed in 49 patients (97.2%). Mean pre ssure after mechanical and pharmacological treatment was 24.1 mmHg. Technic al success was achieved in 100% of the patients. CONCLUSION: The results attest to the efficacy and safety of mechanical fra gmentation and medical thrombolysis in treating massive PTE affecting hemod ynamics, leading to clinical improvement and lowered pulmonary artery press ure.