A 65-year-old male was transferred to our medical center because of circulatory shock from suspected acute myocardial infarction. The coronary angiogram findings, however, were normal. Subsequently, cyanosis and hypotension became worse despite inhalation of enriched oxygen and injection of high doses of dopamine. The pulmonary arterial pressure (68/38mmHg) was almost the same as the systemic blood pressure. Using a percutaneous cardiopulmonary support system (PCPS) and artificial ventilation, pulmonary angiography was performed, and showed vascular cutoff and filling defects in more than 4 lobar arteries due to thromboemboli. Tissuetype plasminogen activator (t-PA) was administered intravenously 6 and a half hours after the onset of symptoms at a dose of 1.6 million IU over one hour, followed by 3.2 million IU/day into the pulmonary artery for 3 consecutive days. After 8 hours of t-PA therapy, a rapid reduction in the abnormally elevated right heart pressure was observed, and we were able to wean the patient off medication. The patient subsequently recovered without any complications from the PCPS. Thus temporary emergency use of PCPS until thrombolysis and recanalization of the obstructed pulmonary vascular beds could be achieved was helpful in preserving both systemic circulation and oxygenation of vital organs, and may increase the likelihood of survival in patients with acute massive pulmonary embolism.
