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case_images: Real-time monitoring of pulmonary artery pressure using a pigtail catheter. (A) Fluoroscopy with ultrasound-assisted catheter-directed thrombolysis catheter in the left and right pulmonary arteries. Pigtail catheter in the trunk of the pulmonary artery. (B, C) Pulmonary artery pressure registration via the EKOS Coolant Port and the pigtail catheter as indicated by arrows.
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case_images: Of note, PAP registration via the cooling port of the EKOS  catheter showed dampened pressure curves (Figure 1). Transthoracic echocardiography showed resolving signs of RV dysfunction (Figure 4 and Table 1).
case_images: Monitoring of heart frequency and SpO2 during ultrasound-assisted catheter-directed thrombolysis. Heart rate in 1/min (lower curve) and SpO2 in % (upper curve) during 900 min of ultrasound-assisted catheter-directed thrombolysis. Dotted lines indicate trend lines.
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case_images: Heart rate was normal during the procedure and SpO2 remained unchanged (Figure 2).
case_images: Real-time pulmonary artery pressure monitoring during ultrasound-assisted catheter-directed thrombolysis. Monitor snapshots prior (A) and post (B) ultrasound-assisted catheter-directed thrombolysis showing electrocardiogram, heart rate, real-time pulmonary artery pressure measured via pigtail in the pulmonary artery, non-invasive blood pressure, and SpO2. (C) Systolic pulmonary artery pressure (upper curve) and diastolic pulmonary artery pressure (lower curve) as a function of time (min). Dotted lines indicate trend lines. UACDT, ultrasound-assisted catheter-directed thrombolysis; PA, pulmonary artery.
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case_images: Pulmonary artery pressure further dropped to 46 mmHg after 15 h (Figure 3).
case_images: Computed tomography pulmonary angiography and transthoracic echocardiography prior and post ultrasound-assisted catheter-directed thrombolysis. Computed tomography pulmonary angiography prior (A) and post (B) ultrasound-assisted catheter-directed thrombolysis indicating nearly complete resolution of pulmonary thrombus. Transthoracic echocardiography prior (C) and post (D) ultrasound-assisted catheter-directed thrombolysis indicating resolving signs of right heart dysfunction. UACDT, ultrasound-assisted catheter-directed thrombolysis.
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case_images: Transthoracic echocardiography showed resolving signs of RV dysfunction (Figure 4 and Table 1). Figure 4 shows the results of CTPA and TTE prior and post UACDT.