{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:23:14Z","timestamp":1787772194447,"version":"build-2784847793"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p>A 40-year-old patient confirmed on computed tomography of the pulmonary arteries (CT\/PAs) a large saddle pulmonary embolus in the main PA extending in both branches. He was managed by ultrasound-supported catheter-directed (EkoSonic, Boston Scientific) intrapulmonary thrombolytic therapy using a recombinant tissue plasminogen activator prolonged infusion over 16 h with a total dose of 50 mg divided in both PAs simultaneously with intravenous unfractionated heparin. He showed clinical improvement with improved arterial oxygen (PaO2) with reduced oxygen therapy with a nasal cannula. Follow-up right heart catheterization showed a significant reduction of PA pressure from 96\/32 (mean 64) to 47\/27 (mean 39) mmHg. Repeat pulmonary angiography showed significant improvement in PA branch opacification, suggesting increased flow and successful therapy. The patient received oral anticoagulants for months. He had followed with CT\/PA and echocardiogram after 4 weeks, both were normalized. He resumed his regular physical activities, including exercises in the gymnasium.<\/jats:p>","DOI":"10.4103\/heartviews.heartviews_103_23","type":"journal-article","created":{"date-parts":[[2024,4,12]],"date-time":"2024-04-12T04:00:58Z","timestamp":1712894458000},"page":"42-45","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Large Saddle Pulmonary Embolism Safely Managed by Ultrasonic-supported Catheter-directed Thrombolytic Therapy"],"prefix":"10.4103","volume":"25","author":[{"given":"Rajeev","family":"Lochan","sequence":"first","affiliation":[{"name":"Department of Cardiology, Al Zahra Hospital, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Momen","family":"Raya","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Al Zahra Hospital, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,4,12]]},"reference":[{"key":"R1-20260505","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1093\/eurheartj\/ehz405","article-title":"2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS)","volume":"41","author":"Konstantinides","year":"2020","journal-title":"Eur Heart J"},{"key":"R2-20260505","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1016\/j.jvir.2009.08.002","article-title":"Catheter-directed therapy for the treatment of massive pulmonary embolism: Systematic review and meta-analysis of modern techniques","volume":"20","author":"Kuo","year":"2009","journal-title":"J Vasc Interv Radiol"},{"key":"R3-20260505","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1177\/1076029616661414","article-title":"Catheter-directed treatment of pulmonary embolism: A systematic review and meta-analysis of modern literature","volume":"23","author":"Tafur","year":"2017","journal-title":"Clin Appl Thromb Hemost"},{"key":"R4-20260505","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1016\/j.jvir.2016.01.012","article-title":"Early experience with AngioVac aspiration in the pulmonary arteries","volume":"27","author":"Al-Hakim","year":"2016","journal-title":"J Vasc Interv Radiol"},{"key":"R5-20260505","first-page":"147","article-title":"Intra pulmonary thrombolytic therapy with balloon dilatation in recurrent acute pulmonary embolism","volume":"36","author":"Lochan","year":"1994","journal-title":"Indian J Chest Dis Allied Sci"},{"key":"R6-20260505","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.thromres.2011.05.014","article-title":"Catheter-directed ultrasound-accelerated thrombolysis for the treatment of acute pulmonary embolism","volume":"128","author":"Engelhardt","year":"2011","journal-title":"Thromb Res"},{"key":"R7-20260505","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.ahj.2011.10.003","article-title":"Single-bolus tenecteplase plus heparin compared with heparin alone for normotensive patients with acute pulmonary embolism who have evidence of right ventricular dysfunction and myocardial injury: Rationale and design of the pulmonary embolism thrombolysis (PEITHO) trial","volume":"163","year":"2012","journal-title":"Am Heart J"},{"key":"R8-20260505","first-page":"2163","article-title":"Phase 1 results: A cooperative study","volume":"214","year":"1970","journal-title":"JAMA"},{"key":"R9-20260505","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1016\/j.jcin.2015.04.020","article-title":"A prospective, single-arm, multicenter trial of ultrasound-facilitated, catheter-directed, low-dose fibrinolysis for acute massive and submassive pulmonary embolism: The SEATTLE II study","volume":"8","author":"Piazza","year":"2015","journal-title":"JACC Cardiovasc Interv"},{"key":"R10-20260505","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1016\/j.jcin.2018.04.008","article-title":"A randomized trial of the optimum duration of acoustic pulse thrombolysis procedure in acute intermediate-risk pulmonary embolism: The OPTALYSE PE trial","volume":"11","author":"Tapson","year":"2018","journal-title":"JACC Cardiovasc Interv"}],"container-title":["Heart Views"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/heartviews.heartviews_103_23","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T18:32:30Z","timestamp":1787769150000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/heartviews.heartviews_103_23"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":10,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.4103\/heartviews.heartviews_103_23","relation":{},"ISSN":["1995-705X","0976-5123"],"issn-type":[{"value":"1995-705X","type":"print"},{"value":"0976-5123","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1]]},"assertion":[{"value":"2023-08-10","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-06","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}