Treatment of massive pulmonary embolism by percutaneous fragmentation of the thrombus.
OBJECTIVE
To evaluate the safety and efficacy of percutaneous thrombus fragmentation (PTF) for massive pulmonary embolism (PE) in patients with contraindications to the administration of thrombolytics.


METHODS
Between July 1999 and August 2005, 10 patients (7 males, 3 females, age 57+/-18 years) with massive PE and contraindications to the administration of thrombolytics underwent PTF. A transthoracic doppler echocardiogram was used to evaluate arterial oxygen saturation (Sat O2), the Walsh index (WI), mean pulmonary artery pressure (PAP), mean systemic blood pressure (SBP) and right ventricular function (RVF) before and after the procedure. Statistical analysis was conducted using the paired Wilcoxon test, of which p was significant when < 0.05.


RESULTS
After the PTF treatment there was an improvement in Sat. O2 [87.4 +/- 1.3% vs 92.3 +/- 3.1% (p < 0.001)], WI [6.4 +/- 1.07 vs 4.4 +/- 1.42 (p = 0.003)], PAP [31.8 +/- 4.6 mmHg vs 25.5 +/- 3.4 mmHg (p < 0.001)] and SBP [73.9 +/- 8.7 vs 85 +/- 8.3 (p = 0.001). The ten patients had severe RVF before the percutaneous treatment; however, within 10 days after PTF, 8 presented normal or discrete function and 1 presented mitigated function. There were no technical or vascular access site complications related to PTF. One patient died in the hospital (10%). The procedure was successful for the other nine patients.


CONCLUSIONS
The lack of adverse complications related to the procedure, proves that PTF is safe. The improvement in Sat O2, WI, PAP, SBP and RVF in 90% of the cases demonstrates the efficacy of the procedure, indicating that it is an alternative treatment for massive PE in patients with contraindications for the administration of systemic thrombolytics.
Barbosa
Marco Antonio Oliveira
MA
Hospital do Coração, Associação Sanatório Sírio, São Paulo, SP, Brazil.
Oliveira
Dinaldo Cavalcanti
DC
Barbosa
Audrey Torres
AT
Pavanello
Ricardo
R
Kambara
Antonio
A
Egito
Enilton Sergio Tabosa
ES
Romano
Edson Renato
ER
Pinto
Ibraim Maschiarelli
IM
Sousa
José Eduardo Moraes Rego
JE
Piegas
Leopoldo Soares
LS
D001794:Blood Pressure / Q000502:physiology; D002404:Catheterization / Q000009:adverse effects / Q000592:standards*; D000075202:Contraindications; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000628:therapy*; D011859:Radiography; D018709:Statistics, Nonparametric; D015912:Thrombolytic Therapy; D013997:Time Factors; D016278:Ventricular Function, Right