Embolectomy Effective in PE Patients With Right Ventricular Dilatation

Mitchel L. Zoler

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ORLANDO -- Pulmonary embolectomy was more effective than anticoagulant therapy for treating pulmonary embolisms in patients with right ventricular dilatation and hemodynamic instability.

"Pulmonary embolectomy is not used enough," Wilbert S. Aronow, M.D., said at the annual meeting of the American College of Cardiology.

"Based on our data, I recommend earlier use of pulmonary embolectomy, especially in patients with severe pulmonary hypertension and right ventricular dilatation," said Dr. Aronow, medical director of the Hebrew Hospital Home in New York. Embolectomy can be done by either thoracotomy or via a catheter, he added.

Dr. Aronow and his associates reviewed 190 patients who were treated at Hebrew Hospital Home for acute pulmonary embolism. The group included 64 patients with right ventricular dilatation, which was diagnosed using two-dimensional echocardiography. Of these 64 patients, 18 were hemodynamically unstable. In contrast, none of the 126 patients without right ventricular dilatation was unstable.

All 126 patients without right ventricular dilatation were treated with intravenous heparin.

Among the 64 patients with right ventricular dilatation, the 18 who were hemodynamically unstable were treated by embolectomy. Another 40 patients were treated with intravenous heparin, and 6 were treated with a combination of intravenous heparin and a thrombolytic agent. This was not a randomized study; the choice of treatment for these 64 patients was made by their physicians.

In-hospital mortality was 11% in the 18 patients treated by embolectomy, 33% in the 6 patients treated with a combination of thrombolytic and anticoagulant agents, and 43% in the 40 patients treated with intravenous heparin only. In-hospital mortality among the 126 patients without right ventricular dilatation was 5%.

At Brigham and Women's Hospital in Boston, 29 patients with pulmonary embolism were treated by embolectomy during a 2-year period, and the mortality rate in this series was also 11%, commented Samuel Z. Goldhaber, M.D., a cardiologist and director of the venous thromboembolism research group at Brigham and Women's Hospital.

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