[Long-term results after local thrombolysis in acute massive pulmonary embolism]

Intrapulmonary arterial infusions of urokinase (mean 1724 IU/kg X h) and heparin (mean 17 IU/kg X h) were given to 7 patients with acute massive pulmonary embolism. Pulmonary angiography and pulmonary artery pressure measurements were performed before, during and 15 months after the drug infusion. During the acute phase, pulmonary artery pressures were recorded daily while urokinase and heparin were administered until the pressures had become normal (after a mean of 6 days). 15 months later right heart catheterization was undertaken before and after ergometric exercise as well as bilateral leg venography. Before treatment pulmonary angiography demonstrated massive vascular obstruction which regressed markedly during and after drug infusion. Treatment also led to normalization of previously elevated pulmonary artery pressures. In addition, pulmonary artery mean pressures and total pulmonary vascular resistance became normal both at rest and on exercise in 6 patients. All patients had signs of acute leg vein thrombosis before treatment, but 15 months later phlebography demonstrated normal findings in 4 and residual findings of previous thrombosis in 3. Local thrombolysis of acute massive pulmonary embolism is thus a highly successful form of treatment.