Goldhaber identified certain findings on transesophageal echocardiography that indicate that a patient with a pulmonary embolus who is at high risk for death or recurrent thromboembolism. This patient may benefit from more aggressive management. The author is from Brigham and Women's Hospital in Boston.
Outcomes:
(1) death
(2) recurrent thromboembolism
High risk findings on transesophageal echocardiography:
(1) moderate to severe right ventricular hypokinesis (as indicated by the ratio of the right ventricular end-diastolic area to the left ventricular end-diastolic area)
(2) persistent pulmonary hypertension
(3) a patent foramen ovale (indicates right atrial pressure > left atrial pressure)
(4) free-floating right heart thrombus
A patient with one or more of these findings may benefit from thombolysis or embolectomy.
Serial transesophageal echocardiography can be used to monitor the response to therapy. Successful therapy is associated with improved right ventricular function and reduced right atrial pressures.
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