Background and study 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.
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.
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.