The results of thrombolytic therapy in submassive pulmonary thromboembolism

Atiye ÇENGEL, Koray DEMİREL, Mehmet KİTAPÇI, Mustafa CEMRİ, Numan EKİM, İ. Kıvılcım OĞUZÜLGEN

Abstract

Thrombolysis appers to be lifesaving in patients with massive pulmonary embolism (PE). The aim of this study was to determine the acute and long term effects of thrombolytic therapy (rt-PA) on right ventricle dimension, systolic pulmonary ar-tery pressure, hemodynamic parameters and the reperfusion of the lung in submassive PE. Six patients (mean age 57.5 ± 12.1, mean symptom time 5.6 ± 3.6 days) were accepted as submassive PE on the bases of clinical suspicion, high-probability ventilation-perfusion lung scan and echocardiographic findings. They all had 100 mg rt-PA/2 hours followed by heparin and warfarin for 3 months. They were evaluated at 24-36 hours of therapy, at day 10 and at the end of anticoagulan therapy. The initial mean end diastolic dimension of right ventricul was 47 + 2.9 mm, dimension of right atrium was 48.5 ± 5.6 mm, maximum systolic pulmonary artery pressure 66.6 + 11.6 mmHg, hearth rate 111 + 19/min, arterial pressure 105/70 mmHg. All these parameters improved significantly at 24-36 hr of rt-PA (40.5 ±5.9 mm, 40 ± 4.3 mm, 39.1 ±16.2 mmHg, 94 ± 5.5/min, 116/76 mmHg respectively, p< 0.05). The improvement was better in day 10. All patients had nearly normal cardiac functions (31.6 ± 4.9 mm, 31 ± 5.7 mm, 28 ± 11.5 mmHg, respectively, p< 0.05) in the 3rd months' of their ECHO control. When the perfusion scans were scored by the degree of pulmonary vasculary obstruction, the initial score was 65.16%. On the 10th day the score decreased to 30.79% (p< 0.05), at the end of 3 months the mean score was 16%. As a result with the use of thrombolytic therapy, cardiac recovery and reperfusion of lung begin early and improvement continues to normal findings at the end of 3 months.

Özet

Masif pulmoner tromboembolide (PTE) trombolitik tedavi ile mortalite ve morbiditenin azaldığı kabul edilmektedir. Bu çalışmanın amacı da ekokardiyografık (EKO) bulgularla submasif PTE tanısı konan hastalarda verilen rt-PA tedavisinin erken ve geç dönemde sağ kalp fonksiyonlarına ve akciğer reperfüzyonuna olan etkisini değerlendirmektir. Semptom, bulgu, ventilasyon-perfüzyon sintigrafisi ve EKO kardiyograflk bulgularla submasif PTE tanısı alan yaş ortalaması 57.5, ortalama semptom süresi 5.6 gün olan 6 hastaya tanı anında 100 mg rt-PA 2 saatlik infüzyonla uygulandı. Infüzyon sonrası heparin ve oral antikoagülanla tedavileri 3 aya tamamlanan hastalar, tedavinin 24-36. saatinde, 10. gününde ve 3. ayında tekrar değerlendirildiler. Başlangıç ortalama diyastol sonu sağ ventrikül çapı 47 ± 2.9 mm, sağ atrium çapı 48.5 ± 5.6 mm, maksimum sistolik pulmoner arter basıncı 66.6 ±11.6 mmHg olan hastaların ortalama kalp hızı 111 ± 19/dakika, kan basıncı 105/70 mmHg idi. Tedavinin 24-36. saatinde bu değerler sırasıyla; 40.5 ± 5.9 mm, 40 ± 4.3 mm, 39.1±16.2 mmHg, 94 ± 5.5/dakika, 116/76 mmHg oldu (p< 0.05). Düzelme 10. günde de devam ederken (p< 0.05), 3. ay kontrolünde kalp fonksiyonlarının ve hemodinaminin tama yakın düzeldiği izlendi (sırasıyla; 31.6 ± 4.9 mm, 31 ± 5.7 mm, 28 ± 11.5 mmHg, p