Saddle pulmonary embolism with normal right ventricular function: a treatment enigma

Management of saddle pulmonary embolism (PE) in haemodynamically stable patients with normal right ventricular (RV) function is unclear. Thrombolytic agents are indicated in haemodynamically unstable patients with PE. RV dysfunction has also been used as an indication for surgical embolectomy in normotensive patients with PE. Embolized thrombus burden, although intuitively related both to haemodynamic status and RV dysfunction, has not been consistently linked to prognosis. In particular, an unsettled issue is the prognosis and benefit of aggressive treatment including thrombolytic agents in hemodynamically stable patients with large pulmonary embolism in the main pulmonary artery (saddle PE) who have no evidence of RV dysfunction. We discuss the management of five patients with saddle pulmonary embolism who were haemodynamically stable and showed normal RV function.