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Ann Thorac Med. 2012 Jul;7(3):157-61. doi: 10.4103/1817-1737.98850.

Novel approach for the management of sub-massive pulmonary embolism.

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1
Division of Pulmonary Medicine, Riyadh Military Hospital, Riyadh, Kingdom of Saudi Arabia.

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

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