Abstract
Seventy-two patients surviving initial treatment by pulmonary embolectomy, streptokinase, or heparin for acute massive pulmonary embolism have been reviewed 1 to 9 years later. Of these patients, 17 had additional cardiorespiratory disease. There were 12 late deaths (41% of those patients with, and 9% of those patients without additional cardiorespiratory disease). No death was due to chronic pulmonary hypertension, and none to certain recurrence of pulmonary embolism. The causes of death were malignant disease (6 patients), cardiopulmonary disease other than pulmonary embolism (4 patients), and 'sudden' (2 patients). Though venous interruption surgery was not used, and long-term anticoagulation rare, the incidence of possible or probable recurrent embolism was low (6%). There was no definite evidence of persistence or subsequent development of pulmonary hypertension after treatment in any patient. Resolution of embolism as judged by symptoms, signs, electrocardiogram, and chest x-ray examination was almost always complete. Some pulmonary arteriograms 1 to 6 months after initial treatment showed minor abnormalities, but others at a later date were normal. Perfusion lung scans carried out 1 to 8 years after initial treatment often showed minor abnormalities.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Crane C., Hartsuck J., Birtch A., Couch N. P., Zollinger R., Jr, Matloff J., Dalen J., Dexter L. The management of major pulmonary embolism. Surg Gynecol Obstet. 1969 Jan;128(1):27–36. [PubMed] [Google Scholar]
- Dalen J. E., Alpert J. S. Natural history of pulmonary embolism. Prog Cardiovasc Dis. 1975 Jan-Feb;17(4):259–270. doi: 10.1016/s0033-0620(75)80017-x. [DOI] [PubMed] [Google Scholar]
- FLEISCHNER F. G. Pulmonary embolism. Clin Radiol. 1962 Jul;13:169–182. doi: 10.1016/s0009-9260(62)80070-1. [DOI] [PubMed] [Google Scholar]
- Hirsh J., Hale G. S., McDonald I. G., McCarthy R. A., Pitt A. Streptokinase therapy in acute major pulmonary embolism: effectiveness and problems. Br Med J. 1968 Dec 21;4(5633):729–734. doi: 10.1136/bmj.4.5633.729. [DOI] [PMC free article] [PubMed] [Google Scholar]
- MAGIDSON O., JACOBSON G. Thrombosis of the main pulmonary arteries. Br Heart J. 1955 Apr;17(2):207–218. doi: 10.1136/hrt.17.2.207. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Miller G. A., Hall R. J., Paneth M. Pulmonary embolectomy, heparin, and streptokinase: their place in the treatment of acute massive pulmonary embolism. Am Heart J. 1977 May;93(5):568–574. doi: 10.1016/s0002-8703(77)80005-7. [DOI] [PubMed] [Google Scholar]
- Miller G. A., Sutton G. C., Kerr I. H., Gibson R. V., Honey M. Comparison of streptokinase and heparin in treatment of isolated acute massive pulmonary embolism. Br Med J. 1971 Jun 19;2(5763):681–684. doi: 10.1136/bmj.2.5763.681. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Murphy M. L., Bulloch R. T. Factors influencing the restoration of blood flow following pulmonary embolization as determined by angiography and scanning. Circulation. 1968 Dec;38(6):1116–1126. doi: 10.1161/01.cir.38.6.1116. [DOI] [PubMed] [Google Scholar]
- PHEAR D. Pulmonary embolism. A study of late prognosis. Lancet. 1960 Oct 15;2(7155):832–835. doi: 10.1016/s0140-6736(60)91903-6. [DOI] [PubMed] [Google Scholar]
- Paneth M. Symposium on safe surgery. Circulatory and respiratory problems. The treatment of pulmonary embolism. Br J Surg. 1967;54(Suppl):468–470. doi: 10.1002/bjs.1800541320. [DOI] [PubMed] [Google Scholar]
- Paraskos J. A., Adelstein S. J., Smith R. E., Rickman F. D., Grossman W., Dexter L., Dalen J. E. Late prognosis of acute pulmonary embolism. N Engl J Med. 1973 Jul 12;289(2):55–58. doi: 10.1056/NEJM197307122890201. [DOI] [PubMed] [Google Scholar]
- Tibbutt D. A., Davies J. A., Anderson J. A., Fletcher E. W., Hamill J., Holt J. M., Thomas M. L., Lee G., Miller G. A., Sharp A. A. Comparison by controlled clinical trial of streptokinase and heparin in treatment of life-threatening pulmonay embolism. Br Med J. 1974 Mar 2;1(5904):343–347. doi: 10.1136/bmj.1.5904.343. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Tow D. E., Wagner H. N., Jr Recovery of pulmonary arterial blood flow in patients with pulmonary embolism. N Engl J Med. 1967 May 11;276(19):1053–1059. doi: 10.1056/NEJM196705112761902. [DOI] [PubMed] [Google Scholar]