The Right Atrial Thrombus: The Sword of Damocles With Real Risk of Massive Pulmonary Embolism

Kirin, Marijan; Cerić, R; Špoljarić, Marko; Pehar, Mario; Cavrić, Gordana; Špoljarić, Ivana Rajčan; Kirin, I

doi:10.1177/0003319707306218

Cited by 9 publications

(7 citation statements)

References 24 publications

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“…The effect of thrombolytic therapy on mortality is controversial. There are favorable results of thrombolytic therapy over heparin in patients with RHT associated PE in a small case series (10,13,(16)(17)(18)(19). First meta-analysis including 119 patients with RHT showed similar efficacy of all three treatment options (8).…”

Section: Discussionmentioning

confidence: 97%

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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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Section: Discussionmentioning

confidence: 97%

“…However a meta-analysis carried out by Rose et al (9) showed lower mortality rate (28.6 %). Kirin et al (13) reported six cases of RHT and two patients received heparin alone died. Whereas, they reported that the rest of four patients survived after thrombolytic therapy.…”

Section: Discussionmentioning

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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“…Type B thrombi are nonmobile adherent thrombi formed by stasis due to decompensated heart disease (congenital or acquired) or to an indwelling foreign body (eg, catheter or pacemaker wire). 3 Type A thrombi, due to their high mobility, are lifethreatening when associated with an acute, symptomatic PE and have a mortality rate of 42%. A PE caused by type B thrombi occurs 40% of the time and usually is not fatal.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2] Right heart thrombi are the source of a PE less than 10% of the time; however, patients with a mobile right heart thrombus have mortality between 21% and 44%. 3 Patients with intravascular foreign bodies, including transvenous pacing wires, are at increased risk for developing right heart thrombi. 4,5 Current treatment recommendations for acute symptomatic PE suggest systemic thrombolytic therapy accelerates resolution of PE and results in rapid hemodynamic improvement.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound Accelerated Catheter Directed Thrombolysis for Pulmonary Embolus and Right Heart Thrombus Secondary to Transvenous Pacing Wires

Amankwah

Seymour

Costanza

et al. 2011

Vasc Endovascular Surg

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Acute pulmonary embolism is associated with a significant number of deaths each year, which are commonly attributed to deep venous thrombosis of the lower extremity. Pulmonary embolism due to right-sided cardiac thrombus associated with transvenous wires is a rare occurrence. Treatment considerations have been systemic anticoagulation with heparin or systemic thrombolytic therapy. A unique case of a patient with symptomatic PE and extensive atrial and ventricle thrombus formation associated with transvenous pacing wires treated with ultrasound accelerated catheter directed thrombolysis is presented.

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“…11 For these reasons, we performed emergency surgical thrombectomy. Although all the thrombi were completely removed and the patient was medicated with Coumadin postoperatively, potentially thrombogenic factors such as AF and severe LV dysfunction remained unchanged after surgery.…”

Section: Images In Cardiovascular Medicine Triple-chamber Cardiac Thrmentioning

confidence: 99%

Triple-Chamber Cardiac Thrombosis in a Patient With Atrial Fibrillation and Severe Left Ventricular Dysfunction

Nishigawa

Takiuchi

Kubo

et al. 2011

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp 74-year-old man with a history of hypertension was admitted for further examination of worsening exertional dyspnea. On admission, his heart rate was 140 beats/min and the rhythm was irregular. An ECG showed atrial fibrillation (AF) and chest X-ray revealed increased cardiothoracic ratio, with pulmonary congestion and bilateral pleural effusion. Transthoracic echocardiography (TTE) demonstrated a large mural thrombus in the left ventricular (LV) apex and severe LV dysfunction, with fractional shortening of 11% and diffuse, severe hypokinetic wall motion ( Figure 1A). Moderate mitral regurgitation (MR), because of leaflet tethering, and enlarged atria were also detected. A small mass lesion detected in the right atrium (RA) was considered to be a thrombus. Because the patient was not taking any medication other than antihypertensive drugs, administration of diuretics and anticoagulant drugs was promptly initiated. Laboratory data showed normal levels of proteins C and S, and negative antiphospholipid antibodies. Follow-up TTE (3 days later) revealed that the thrombus in the LV apex had become a 20×16 mm mobile thrombus, and the mass lesion in the RA had increased in size to 22×22 mm ( Figure 1B). Coronary angiography showed a normal coronary artery. He was referred for surgical treatment of the mobile thrombus in the LV apex and the mass lesion in the RA. Post-induction transesophageal echocardiography detected the thrombus in the left atrial appendage (LAA) (Figure 2 IMAGES IN CARDIOVASCULAR MEDICINE

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The Right Atrial Thrombus: The Sword of Damocles With Real Risk of Massive Pulmonary Embolism

Abstract: patients have a high incidence of massive pulmonary embolism with high mortality rate (from 29% to 100%), higher than the 8% to 10% of pulmonary embolism in general.

Cited by 9 publications

References 24 publications

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

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

Ultrasound Accelerated Catheter Directed Thrombolysis for Pulmonary Embolus and Right Heart Thrombus Secondary to Transvenous Pacing Wires

Triple-Chamber Cardiac Thrombosis in a Patient With Atrial Fibrillation and Severe Left Ventricular Dysfunction

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