Successful Treatment of Right Heart Thrombi and Acute Massive Pulmonary Embolism by Repeated Thrombolysis

We present the case of a 19 year old female who underwent a massive pulmonary embolism with thrombus in right ventricle (RV) and acute RV failure. Thrombolytic treatment had failed and repeated thrombolysis was given after 24 hours. Treatment was successful and on the eleventh day of hospitalization the patient was discharged. The current guidelines do not give clear directions for the management of patients with acute massive pulmonary embolism who do not respond to fibrinolytic therapy. A repeated thrombolysis could be an alternative treatment over surgical embolectomy for these patients.