Pulmonary embolism: Influence of cardiac hemodynamics and natural history on selection of patients for embolectomy and inferior vena cava ligation

Twenty-five patients with angiographic evidence of pulmonary embolism were studied hemodynamically. Survival of these patients was influenced predominantly by the stroke index and type of therapy, rather than the degree of pulmonary or right ventricular end diastolic hypertension. Ligation of the inferior vena cava was performed, without a hospital death, in 17 of these 25 patients. Of these 17 patients, 14 had pulmonary hypertension, 9 had abnormal right ventricular end diastolic pressures, and 9 had subnormal stroke indices. The degree of abnormal hemodynamics did not preclude patient survival without pulmonary embolectomy. Five patients with subnormal stroke indices were treated conservatively, with only one survivor. Thirty patients were serially examined for resolution of pulmonary emboli. The latter occurred in 14 of 15 patients without cardiac or pulmonary disease, but resolution of pulmonary emboli was found in only 2 of 15 patients with pre-existing cardiopulmonary disease.