Parro Júnior A, da Silveira L C, Thevenard R S, Stefano G V, Lesse P, Machado N C, de Araújo J D, Anacleto J C, Nicolau J C
Instituto de Moléstias Cardiovasculares, São José do Rio Preto.
Arq Bras Cardiol. 1993 Mar;60(3):157-63.
The aim of the study was to analyse the role of 2D echocardiogram (ECHO) in the diagnosis of massive pulmonary embolism (PE), and in the follow-up after fibrinolytic or surgical treatment.
Echocardiographic studies were retrospectively analysed in seven patients, 5 male, mean age 37 +/- 19 years, with massive pulmonary embolism (PE) confirmed by pulmonary angiography. Six of them were submitted to fibrinolytic therapy with IV streptokinase (SK), and one underwent surgery. The diagnosis of PE by ECHO was made by the detection of thrombi in the pulmonary vascular bed. ECHO measurements included the right ventricular diastolic diameter (RVDD), interventricular septal motion (IVS), acceleration time (AcT), and peak pulmonary artery pressure (PAP).
The ECHO study diagnosed thrombi in five out of seven patients (71%), mainly if they were present in the right main pulmonary artery (four cases -80%). It was also able to locate one out of five patients with thrombus in the right lobar artery and one out of two patients in the left main pulmonary artery; it was unable to identify six patients with involvement of the left lobar arteries. Four out of five patients with PE, diagnosed by ECHO, were submitted to fibrinolytic therapy, and one underwent surgery. The follow-up study showed dissolution of the thrombus in three of those with SK and in the one with surgical treatment. The initial ECHO study showed five out of 7 patients with increased RVDD, 5/7 patients with abnormal IVS motion, and all of them with decreased AcT (64 +/- 16 ms). The PSP was 64.4 +/- 22.8 mmHg by ECHO, versus 75.4 +/- 24.03 mmHg by angiography (r = 0.78; p = 0.11). There was a reduction of the RVDD (30 +/- 5.02 to 23 +/- 2.2) and an increased of the AcT (50 +/- 10.8 to 106.67 +/- 16) at the serial examination.
The ECHO study is an important tool for the diagnosis of PE, informing about pulmonary pressure, presence and position of thrombus, and treatment results.
本研究旨在分析二维超声心动图（ECHO）在大面积肺栓塞（PE）诊断以及纤溶或手术治疗后随访中的作用。
回顾性分析7例经肺血管造影确诊为大面积肺栓塞（PE）患者的超声心动图研究，其中男性5例，平均年龄37±19岁。6例接受静脉注射链激酶（SK）纤溶治疗，1例接受手术治疗。通过检测肺血管床内血栓来进行ECHO对PE的诊断。ECHO测量包括右心室舒张直径（RVDD）、室间隔运动（IVS）、加速时间（AcT）和肺动脉峰值压力（PAP）。
ECHO研究在7例患者中的5例（71%）诊断出血栓，主要是在右主肺动脉存在血栓的情况（4例 - 80%）。它还能定位出右叶动脉有血栓的5例患者中的1例以及左主肺动脉有血栓的2例患者中的1例；无法识别6例左叶动脉受累的患者。经ECHO诊断为PE的5例患者中，4例接受纤溶治疗，1例接受手术。随访研究显示，接受SK治疗的3例患者以及接受手术治疗的1例患者的血栓溶解。初始ECHO研究显示7例患者中有5例RVDD增加，5/7例患者IVS运动异常，且所有患者AcT均降低（64±16毫秒）。ECHO测得的PSP为64.4±22.8毫米汞柱，而血管造影测得的为75.4±24.03毫米汞柱（r = 0.78；p = 0.11）。在系列检查中，RVDD减小（从30±5.02降至23±2.2），AcT增加（从50±10.8升至106.67±16）。
ECHO研究是诊断PE的重要工具，可提供有关肺压力、血栓的存在与位置以及治疗结果的信息。
