title: [Hemodynamic impact of thrombolytic therapy in acute pulmonary thromboembolism].
abstract: OBJECTIVE
  To evaluate pre and post-hemodynamic changes after thrombolytic therapy in patients with acute pulmonary embolism with multiple pulmonary segments compromised.
  
  
  METHODS
  Nine patients, 5 females, aged between 27 and 83 (mean 62 +/- 16) years, with the onset of symptoms preceding 7 days, were submitted to thrombolytic therapy, administered after baseline perfusion-ventilation lung scan, echodopplercardiography (ECO) and hemodynamic measurements with a Swan-Ganz thermodilution catheter. The same procedures were done after the thrombolytic infusion. Streptokinase (SK) was used in 7 (78%) cases and recombinant human tissue-type plasminogen activator (rt-PA, alteplase) in 2 with the following doses: SK-250,000 i.u. infusion over 30 min, then 100,000 i.v/h over 24 to 72 h and rt-PA-20 mg in bolus infusion, then 80 mg over 6 h. Thrombolytic was infused in pulmonary artery trunk in 8 (88%) cases and a peripheral vein in 1 (12%) case, until mean pulmonary artery pressure (PAP) reached 20 mmHg. All patients received i.v. heparin and oral anticoagulation after thrombolytic therapy.
  
  
  RESULTS
  A significant (p < 0.05) decrease in right atrial pressure (12 +/- 3 vs 8 +/- 2 mmHg), PAP (32 +/- 5 vs 19 +/- 2 mmHg), pulmonary vascular resistance (397 +/- 125 vs 87 +/- 24 dyne.s/cm5) and increase in cardiac output (3.4 +/- 0.5 vs 5.5 +/- 1.0 l/min) and stroke volume (30 +/- 5 vs 57 +/- 10 ml/beat) were observed after thrombolytic infusion. Two patients died as a result of pulmonary infection unrelated to the embolic event or thrombolysis. Minor bleeding complications occurred in two cases and major in one patient with orthopedic prosthesis.
  
  
  CONCLUSIONS
  Thrombolytic therapy exert desirable effects on hemodynamic abnormalities, achieving lungs scan and ECO improvement in patients with acute pulmonary embolism.
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo.
authors.forename: A C
authors.initials: AC
authors.lastname: Baruzzi
authors.forename: E
authors.initials: E
authors.lastname: Knobel
authors.forename: C
authors.initials: C
authors.lastname: Cirenza
authors.forename: M R
authors.initials: MR
authors.lastname: Smith
authors.forename: C S
authors.initials: CS
authors.lastname: Barbas
authors.forename: C J
authors.initials: CJ
authors.lastname: Fernandes Júnior
authors.forename: N
authors.initials: N
authors.lastname: Akamine
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002407:Catheterization, Swan-Ganz; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D011877:Radionuclide Imaging; D015912:Thrombolytic Therapy
chemical_list: D005343:Fibrinolytic Agents
vernacular_title: Repercussões hemodinâmicas da terapia trombolítica no tromboembolismo pulmonar agudo.