Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Jul;7(3):157-61.
doi: 10.4103/1817-1737.98850.

Novel approach for the management of sub-massive pulmonary embolism

Majdy M Idrees  1 , Enas Batubara, Tarek Kashour
Affiliations

Novel approach for the management of sub-massive pulmonary embolism

Majdy M Idrees et al. Ann Thorac Med. 2012 Jul.

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.

Conclusion: In SPE, directing therapy toward decreasing pulmonary vascular resistance improves the associated pulmonary hemodynamic compromise and improves RV function.

Keywords: Iloprost; pulmonary hypertension; pulmonary vascular resistance; right ventricular function; sub-massive pulmonary embolism.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
The mean of sPAP by Echo, NT-pro BNP, 6 MWT, and WHO FC (pre and post Iloprost)
Figure 2
Figure 2
Helical CT for Case 2
Figure 3
Figure 3
Algorithm for management of sub-massive PE
See this image and copyright information in PMC

References

    1. Konstantinides S, Geibel A, Olschewski M, Heinrich F, Grosser K, Rauber K, et al. Association between thrombolytic treatment and the prognosis of hemodynamically stable patients with major pulmonary embolism: results of a multicenter registry. Circulation. 1997;96:882–8. - PubMed
    1. Dalen JE. The uncertain role of thrombolytic therapy in the treatment of pulmonary embolism. Arch Intern Med. 2002;162:2521–3. - PubMed
    1. Kasper W, Konstantinides S, Geibel A, Olschewski M, Heinrich F, Grosser KD, et al. Management strategies and determinants of outcome in acute major pulmonary embolism: Results of a multicenter registry. J Am Coll Cardiol. 1997;30:1165–71. - PubMed
    1. Hamel E, Pacouret G, Vincentelli D, Forissier JF, Peycher P, Pottier JM, et al. Thrombolysis or heparin therapy in massive pulmonary embolism with right ventricular dilation: Results from a 128-patient monocenter registry. Chest. 2001;120:120–5. - PubMed
    1. Smulders YM. Pathophysiologu and treatment of hemodynamic instability in acute pulmonary embolism: The pivotal role of pulmonary vasoconstriction. Cardiovasc Res. 2000;48:23–33. - PubMed