Right heart thrombi: Consider the cause

Finlayson, Gordon N.

doi:10.1016/s0828-282x(08)70713-x

Cited by 27 publications

(26 citation statements)

References 10 publications

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“…Despite the elevated risk, clinical management of these patients remains controversial, with guidelines being silent or equivocal about optimal management 11, 17, 18. Thrombolysis carries the potential risk of further pulmonary emboli as a result of partial dissolution of the thrombi 19. In a recent propensity‐matched investigation, use of reperfusion was associated with a nonsignificant reduction in risk of PE‐related mortality 20.…”

Section: Discussionmentioning

confidence: 99%

Early Use of Echocardiography in Patients With Acute Pulmonary Embolism: Findings From the RIETE Registry

Bikdeli

Lobo

Jiménez

et al. 2018

JAHA

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BackgroundTransthoracic echocardiography (TTE) is often considered for risk stratification of patients with acute pulmonary embolism (PE). We sought to determine the contemporary utilization of early TTE (within 72 hours of PE diagnosis) and explored the association between TTE findings and PE‐related mortality.Methods and ResultsData from the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry, a multicenter registry of consecutive patients with acute PE, were used (2001–July 2017). We used a generalized linear mixed model to determine predictors of early TTE performance. Moreover, the association between 3 TTE variables (right atrial enlargement, right ventricular hypokinesis, and presence of right heart thrombi) and 30‐day PE‐related mortality was assessed in generalized linear mixed models adjusted for PE severity index, and other comorbidities. Among 35 935 enrollees with acute PE, 15 375 (42.8%) underwent early TTE. There was an increase in early TTE utilization rate over time (P<0.001 for trend). Younger age, female sex, enrollment in countries other than Spain, history of coronary disease, heart failure, atrial fibrillation, tachycardia, and hypotension were the main predictors of early TTE (P<0.01 for all). In multivariable analyses, right atrial enlargement (adjusted odds ratio: 3.74; 95% confidence interval, 2.10–6.66), right ventricular hypokinesis (adjusted odds ratio: 3.11, 95% confidence interval: 1.85–5.21) and right heart thrombi (adjusted odds ratio: 4.39, 95% confidence interval, 1.99–9.71) were associated with increased odds for PE‐related mortality.ConclusionsEarly TTE is commonly performed for acute PE and utilization rates have increased over time. Right atrial enlargement, right ventricular hypokinesis, and right heart thrombi are predictive of worse outcomes.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02832245.

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Section: Discussionmentioning

confidence: 99%

Early Use of Echocardiography in Patients With Acute Pulmonary Embolism: Findings From the RIETE Registry

Bikdeli

Lobo

Jiménez

et al. 2018

JAHA

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“…RA thrombosis is a rare phenomenon, and has been reported under specific circumstances such as endocardial pacing 9 , and the condition is likely underdiagnosed 10 . Significant tricuspid regurgitation, low cardiac output, pulmonary hypertension and decreased pulmonary blood flow are predisposing parameters 18 , 19 . In some clinical cases, it is found that RA thrombi are in transit, having migrated from the venous system to the heart; 10 , 18 which may predispose to pulmonary embolism.…”

Section: Discussionmentioning

confidence: 99%

Investigation of Atrial Vortices Using a Novel Right Heart Model and Possible Implications for Atrial Thrombus Formation

Gülan

Saguner

Akdiş

et al. 2017

Sci Rep

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The main aim of this paper is to characterize vortical flow structures in the healthy human right atrium, their impact on wall shear stresses and possible implications for atrial thrombus formation. 3D Particle Tracking Velocimetry is applied to a novel anatomically accurate compliant silicone right heart model to study the phase averaged and fluctuating flow velocity within the right atrium, inferior vena cava and superior vena cava under physiological conditions. We identify the development of two vortex rings in the bulk of the right atrium during the atrial filling phase leading to a rinsing effect at the atrial wall which break down during ventricular filling. We show that the vortex ring formation affects the hemodynamics of the atrial flow by a strong correlation (ρ = 0.7) between the vortical structures and local wall shear stresses. Low wall shear stress regions are associated with absence of the coherent vortical structures which might be potential risk regions for atrial thrombus formation. We discuss possible implications for atrial thrombus formation in different regions of the right atrium.

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“…Right heart thrombi can also be immobile and is believed to form in situ with underlying cardiac abnormalities. These immobile thrombi have unknown prevalence but generally result in better outcomes 7. In this case, the thrombi had neovascularization and it clearly had a stalk that was attached to the RA septum.…”

Section: Discussionmentioning

confidence: 82%

Clot in Lung, Clot in Heart: A Case Report of Tumor-Like Thrombus in Right Atrium

Habibi

Altamirano

Dadkhah

2017

Clin Med Insights Case Rep

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Tumor-like formation of thrombus in the right atrial cavity is rare. It may be mistaken for a myxoma. The exact pathophysiology of an isolated thrombus in the heart is still unclear. Management to prevent complications such as pulmonary thromboembolism depends on the clinical judgment of a cardiologist. This report describes a 76-year-old woman with right atrial thrombus causing subsequent pulmonary thromboembolism in right lung. She initially presented to us with pulmonary embolism, and later, an incidental finding of a mass in her right atrium revealed an association of thrombus in heart with thrombus in lung. The challenging management was to resect this thrombus which was fixed to atrial septum, and a trial of anticoagulation did not resolve it. Exact management of such incidental findings in right heart cavities is not well established. Some cases may benefit from resection of such formed fixed thrombus.

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Right heart thrombi: Consider the cause

Cited by 27 publications

References 10 publications

Early Use of Echocardiography in Patients With Acute Pulmonary Embolism: Findings From the RIETE Registry

Early Use of Echocardiography in Patients With Acute Pulmonary Embolism: Findings From the RIETE Registry

Investigation of Atrial Vortices Using a Novel Right Heart Model and Possible Implications for Atrial Thrombus Formation

Clot in Lung, Clot in Heart: A Case Report of Tumor-Like Thrombus in Right Atrium

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