Floating Right Heart Thrombi and Pulmonary Embolism: Diagnosis, Outcome and Therapeutic Management

Chapoutot, L; Nazeyrollas, Pierre; Metz, Damien; Maes, D; Maillier, B; Jennesseaux, C; Elaerts, J

doi:10.1159/000177081

Cited by 124 publications

(95 citation statements)

References 13 publications

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“…Central venous catheterrelated PE occur more often with thrombi adherent to catheters (sleeve thrombi) compared to venous wall (mural thrombi). 30,31 In summary, PE occurs in up to one-third of patients with UEDVT and in 15 to 20% of those with CVC-related UEDVT.…”

Section: Risk For Pulmonary Embolismmentioning

confidence: 99%

“…In two cohort studies involving 200 and 130 patients with confirmed PE, RHTE were detected, primarily by transthoracic echocardiography (TTE), in 7 and 18% of subjects, respectively. 31,32 A postmortem study documented concurrent RHTE and PE in 6% of cases. 33 More recently, the International Cooperative Pulmonary Embolism Registry 34 reported RHTE in 4% of 1,113 patients with PE undergoing echocardiography.…”

Section: Risk For Pulmonary Embolismmentioning

confidence: 99%

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A critical review of thromboembolic complications associated with central venous catheters

Burns

McLaren

2008

Can J Anesth/J Can Anesth

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Purpose: Central venous catheters (CVC) are commonly used in critical care. While thrombosis is a well-recognized and frequent complication associated with their use, CVC-related thromboembolic complications, including pulmonary embolism (PE) and right heart thromboembolism (RHTE), occur less frequently and often evade diagnosis. Little information exists to guide clinicians in the diagnosis and management of CVC-related thromboembolic complications. Source:We critically review and synthesize the literature highlighting the incidence of CVC-related thrombosis. We highlight the risk for developing thromboembolic complications and provide approaches to diagnosing and managing RHTE. Principle findings:The incidence of CVC-related thrombosis varies depending on patient, site, instrument, and infusaterelated factors. Central venous catheters-related thrombosis represents an important source of morbidity and mortality for affected patients. Pulmonary embolism occurs in approximately 15% of patients with CVC-related upper extremity deep venous thrombosis (UEDVT). More frequent use of transesophageal echocardiography, in patients with suspected and confirmed PE, has resulted in increased detection of RHTE. While it is recognized that the occurrence of RHTE, in association with PE, increases mortality, the optimal strategy for their management has not been established in a clinical trial. Conclusion:Central venous catheter-related thrombosis occurs frequently and represents an important source of morbidity and mortality for affected patients. Our review supports that surgery and thrombolysis have both been demonstrated to enhance survival in patients with RHTE and PE. However, important patient, clot, and institutional considerations mandate that treatment for patients with RHTE and PE be individualized.

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Section: Risk For Pulmonary Embolismmentioning

confidence: 99%

Section: Risk For Pulmonary Embolismmentioning

confidence: 99%

A critical review of thromboembolic complications associated with central venous catheters

Burns

McLaren

2008

Can J Anesth/J Can Anesth

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“…4 But, there is no consensus related to management of the right atrial thrombi, which is less than 2 cm in diameter. It is recommended emergent surgery in these patients when thrombi greater than 2 cm in diameter.…”

Section: Discussionmentioning

confidence: 99%

Right atrial pseudomyxoma originated from junction between right atrial wall and tricuspid ring annuloplasty

et al. 2016

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“…Previous studies have reported the prevalence of RHT in PE cases between 7% and 18% (1,2). Detection of RHT is very important because of documented high mortality rate (>40%) (3,4).…”

Section: Introductionmentioning

confidence: 99%

Management of right heart thrombi associated with acute pulmonary embolism: a retrospective, single-center experience

Akıllı

Gül²,

Arıbaş³

et al. 2013

Anadolu Kardiyol Derg

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Objective: The mortality of right heart thrombi (RHT) associated with pulmonary embolism (PE) is increased about three to four times. The most devastating scenario is fragmentation of RHT and occurrence of recurrent PE. The reports regarding the management of RHT complicated with PE are very scarce in the current literature. Therefore, we report a single-center experience in this paper. Methods: From January 2006 to December 2011, data of all patients diagnosed with acute PE were analyzed retrospectively. Of the 312 acute PE cases confirmed with computed tomography, total 35 patients who were diagnosed with concomitant RHT (prevalence of 11%) by echocardiography were recruited. After excluding of six patients with metastatic malignancy a total 29 patients were accepted eligible for the analysis. In addition, catheter -induced thrombus (type B) were not included to the study. The difference between categorical variables was analyzed with Chi-square test and continuous variables were analyzed with Mann-Whitney U test. A p value of <0.05 was considered statistically significant. Results: Overall mortality was high (34%) in study population: among undergoing surgery-100%, therapy with thrombolytics -18%, and heparin -27%. Troponin levels were found significantly higher in died patients than that in survived patients (p=0.03). There was no significant difference regarding to clinical and echocardiographic characteristics of patients received heparin versus thrombolytic except for shock index (p=0.02). In addition, patients treated with heparin had increased duration of hospitalization compared to subjects treated with thrombolytic (median: 8 vs 3 days p<0.01). Conclusion: Despite of the low incidence of RHT, a mortal course is still an important problem during PE. The decision on treatment modality should be performed based on the hemodynamic parameters, laboratory findings, and bleeding risk of the patients. (Anadolu Kardiyol Derg 2013; 13: 528-33) Key words: Right heart thrombus, pulmonary embolism, thrombolysis, mortality Original Investigation Özgün Araşt›rma 528ÖZET Amaç: Pulmoner emboli (PE) ile ilişkili sağ kalp trombüslerinin mortalitesi 3-4 kat artmaktadır. En korkulan senaryo ise sağ kalp trombüslerinin parçalanması sonucunda rekürren pulmoner emboli gelişmesidir. Pulmoner embolilere eşlik eden sağ kalp trombüsü vakalarının tedavisi zordur ve bu konu ile ilgili literatürde yeterli veri bulunmamaktadır. Yöntemler: Ocak 2006 ila Aralık 2011 tarihleri arasında akut pulmoner emboli tanısı almış 312 hastanın verileri retrospektif olarak incelendi. Bilgisayarlı tomografi ile tanı almış 312 akut PE hastalarından ekokardiyografide sağ kalp trombüsü bulunan 35 hasta çalışmaya alındı. Metastatik malignansi bulunan 6 hasta çalışmadan dışlandı. Yirmi dokuz hasta değerlendirilme için uygun bulundu. Hastaların ekokardiyografik raporları da incelendi. Ayrıca katetere bağlı gelişen trombüs (tip B) vakaları da çalışmaya dahil edilmedi. Kategorik değişkenlerin karşılaştırılmasında Ki-kare ve non-parametrik sürekli de...

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Floating Right Heart Thrombi and Pulmonary Embolism: Diagnosis, Outcome and Therapeutic Management

Cited by 124 publications

References 13 publications

A critical review of thromboembolic complications associated with central venous catheters

A critical review of thromboembolic complications associated with central venous catheters

Right atrial pseudomyxoma originated from junction between right atrial wall and tricuspid ring annuloplasty

Management of right heart thrombi associated with acute pulmonary embolism: a retrospective, single-center experience

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