title: Early interventional therapy for acute massive pulmonary embolism guided by minimally invasive hemodynamic monitoring.
abstract: OBJECTIVE
  The aim of this study was to investigate the clinical significance of minimally invasive hemodynamic monitoring in the early catheter-based intervention for acute massive pulmonary embolism (PE).
  
  
  METHODS
  A total of 40 cases with acute massive PE were randomized into experimental and control group with 20 cases in each group. In the experimental group, the hemodynamics was monitored via Vigileo/FloTrac system, while echocardiography was used in the control group. Twelve hours after systemic thrombolysis, catheter-based clot fragmentation and local thrombolysis were employed in the experimental group if Vigileo/FloTrac system revealed hemodynamic abnormality. For the control group, the application of catheter was determined by the findings in echocardiography at 24 hours after systemic thrombolysis.
  
  
  RESULTS
  A total of 12 cases in the experimental group underwent catheter therapy successfully while 4 cases in the control group received the same treatment. Compared to the control group, 12 hours after catheter intervention the experimental group had higher PaO2/FIO2 and right ventricular ejection fraction (RVEF) but lower pulmonary artery systolic pressure (PASP), indicating the effectiveness of Vigileo/FloTrac monitoring. The 28-day survival rates were identical between the groups although one patent in the control group died. Both the RVEF and PASP were significantly improved in the experimental group in 6 months compared to the control group.
  
  
  CONCLUSIONS
  In massive PE, hemodynamic monitoring via Vigileo/FloTrac system might be useful in the decision making for catheter intervention after systemic thrombolysis and might improve the outcomes for patients.
authors.affiliation: Department of Surgery, Quzhou People's Hospital, Zhejiang University Quzhou, Zhejiang, China.
authors.forename: Lihua
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Surgery, Quzhou People's Hospital, Zhejiang University Quzhou, Zhejiang, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Surgery, Quzhou People's Hospital, Zhejiang University Quzhou, Zhejiang, China.
authors.forename: Weiwen
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Surgery, Quzhou People's Hospital, Zhejiang University Quzhou, Zhejiang, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Lu
authors.affiliation: Department of Surgery, Quzhou People's Hospital, Zhejiang University Quzhou, Zhejiang, China.
authors.forename: Meiqin
authors.initials: M
authors.lastname: Chen
authors.affiliation: Department of Surgery, Quzhou People's Hospital, Zhejiang University Quzhou, Zhejiang, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Luo
keywords: Acute massive pulmonary embolism; Vigileo/FloTrac; hemodynamic