Cuccia C, Franzoni P, Volpini M, Scalvini S, Volterrani M, Musmeci G, Metra M
Cattedra di Cardiologia, Università degli Studi, Brescia.
Cardiologia. 1990 Sep;35(9):781-6.
In 4 consecutive patients admitted for multiple pulmonary embolism 2-dimensional echocardiography showed large right atrial migrant thromboemboli in transit, floating and prolapsing into the right ventricle in diastole. This pattern was always associated with the echocardiographic signs of pulmonary hypertension. All the patients were treated with intravenous infusion of 100 mg of rt-PA in 3 hours. rt-PA determined the dissolution and disappearance of the right atrial thromboemboli (it took 4 hours in 2 patients and 5 hours in the remaining 2), and the concomitant disappearance of the echocardiographic signs of pulmonary hypertension. During and after the rt-PA therapy there was no evidence of further pulmonary embolism. The fibrinolytic treatment for right atrial thromboemboli during multiple pulmonary embolism is a promising alternative to right atrial thrombectomy: our results indicate that rt-PA acts rapidly and is effective and safe; if these results will be confirmed in a larger group of patients, rt-PA could become the first-choice therapy of right atrial thromboembolus.
在4例因多发性肺栓塞入院的连续患者中，二维超声心动图显示右心房有大量移动性血栓栓子，在舒张期漂浮并脱垂入右心室。这种模式总是与肺动脉高压的超声心动图征象相关。所有患者均在3小时内静脉输注100mg重组组织型纤溶酶原激活剂（rt-PA）。rt-PA使右心房血栓栓子溶解并消失（2例患者用时4小时，其余2例用时5小时），同时肺动脉高压的超声心动图征象也随之消失。在rt-PA治疗期间及之后，没有进一步发生肺栓塞的证据。在多发性肺栓塞期间，对右心房血栓栓子进行纤溶治疗是右心房血栓切除术的一种有前景的替代方法：我们的结果表明，rt-PA起效迅速，有效且安全；如果这些结果能在更大规模的患者群体中得到证实，rt-PA可能会成为右心房血栓栓子的首选治疗方法。
