Modern Diagnosis and Therapy of Massive Pulmonary Embolism

Overview

Pulmonary embolism is classified in acute cardiologic conditions, which require rapid andprecise evaluation of the situation for an effective and safe therapy. In case of sub-massivepulmonary embolism in patients with stabilized circulation the long-term results of conservativeanticoagulation therapy (i.e. non-fractionated or low-molecular weight heparin and subsequentdicoumarol preparations) identical with a decisive treatment with thrombolytic agents.In patients suffering from severe circulation instability or massive embolism, an early diagnosisof “invasive” therapy may improve the chance for survival or decrease subsequent functionaldeficit. The therapy to be considered is:1) Systemic administration of thrombolytic agents2) Selective intrapulmonary thrombolysis (supplemented with mechanical fragmentation andaspiration of the embolus by catheter) and3) Acute surgical pulmonary embolectomy with the use of sternotomy and pericardiotomy.In our conditions the first two procedures are mostly to be considered and are therefore describedin more detail. The description is based on the case histories of four patients with massivepulmonary embolism, successfully treated at our ward by selective thrombolysis with theapplication of four different regimens of administration.

Key words:
pulmonary embolism – thrombolysis – cardiopulmonary resuscitation – catheterization.