title: Novel approach for the management of sub-massive pulmonary embolism.
abstract: BACKGROUND
  Right ventricular (RV) dysfunction has been identified as a poor prognostic indicator in sub-massive pulmonary embolism (SPE). We hypothesized that using selective vasodilator agent is beneficial in improving RV function in patients with this condition.
  
  
  METHODS
  We used inhaled prostacyclin analogue (Iloprost, Ventavis(®)) in five patients with SPE. Helical computerized tomography angiogram was confirmatory for pulmonary embolism and echocardiography was used to evaluate the RV status. All patients received inhaled Iloprost, 2.5 to 5 μg every 4 hours for 3 weeks.
  
  
  RESULTS
  Patients were prospectively followed for 3 months. They were assessed at baseline before starting Iloprost treatment and at 3 days, 3 weeks, and 3 months after treatment. All patients showed significant improvement in their functional class, Borg dyspnea score, NT pro-BNP level, and echocardiographic parameters.
  
  
  CONCLUSIONS
  In SPE, directing therapy toward decreasing pulmonary vascular resistance improves the associated pulmonary hemodynamic compromise and improves RV function.
authors.affiliation: Division of Pulmonary Medicine, Riyadh Military Hospital, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Majdy M
authors.initials: MM
authors.lastname: Idrees
authors.forename: Enas
authors.initials: E
authors.lastname: Batubara
authors.forename: Tarek
authors.initials: T
authors.lastname: Kashour