title: Successful treatment of right heart thromboemboli with IV recombinant tissue-type plasminogen activator during continuous echocardiographic monitoring: a case series report.
abstract: OBJECTIVE
  Echocardiographic detection of right heart thromboemboli (RHTE) during pulmonary embolism (PE) shows an uncommon but life-threatening event. The treatment of this condition is not well established. The aim of our study is to evaluate the efficacy and safety of recombinant tissue-type plasminogen activator (rt-PA) in treating RHTE.
  
  
  METHODS
  We performed a transthoracic echocardiogram within (mean +/- SD) 120+/-45 min from onset of symptoms on 30 consecutive patients with proven massive PE. Seven patients (23%) showed RHTE, four patients (57%) had cardiogenic shock; and all patients showed echocardiographic features of acute cor pulmonale. The seven patients with RHTE received an IV infusion of 100 mg rt-PA over a period of 2 h with continuous echocardiographic monitoring.
  
  
  RESULTS
  We observed complete RHTE lysis at 45 to 60 min from the onset of rt-PA infusion and significant reductions at 2 h in the following: 14% in right ventricle (RV) end-diastolic diameter (reduction, 40.8 to 35 mm; p < 0.01); 12% in RV/left ventricular ratio (reduction, 0.83 to 0.73; p < 0.01); and 17% in tricuspid regurgitant flow velocity (reduction, 3.5 to 2.9 m/s; p < 0.01). The interventricular septal and RV wall motions improved. An excellent clinical outcome was achieved rapidly in all patients. No adverse events were recorded.
  
  
  CONCLUSIONS
  We demonstrated the rapid, effective, and safe action of rt-PA in RHTE resolution and an improvement in pulmonary perfusion. Our data confirm the important role of an early, systematic echocardiographic approach in order to detect RHTE quickly in patients with suspected massive PE.
authors.affiliation: Division of Cardiology, Ospedale Civile Annunziata, Cosenza, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Greco
authors.forename: G
authors.initials: G
authors.lastname: Bisignani
authors.forename: O
authors.initials: O
authors.lastname: Serafini
authors.forename: D
authors.initials: D
authors.lastname: Guzzo
authors.forename: A
authors.initials: A
authors.lastname: Stingone
authors.forename: F
authors.initials: F
authors.lastname: Plastina
mesh_terms: D000368:Aged; D004452:Echocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008991:Monitoring, Physiologic; D011655:Pulmonary Embolism / Q000150:complications* / Q000000981:diagnostic imaging; D013923:Thromboembolism / Q000000981:diagnostic imaging / Q000188:drug therapy*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator