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Watson NW, Weinberg I, Dicks AB, Fong E, Strom JB, Carroll BJ, Raja A, Schainfeld R, Secemsky EA. Clinical Significance of Right Heart Thrombus With and Without an Associated Pulmonary Embolism. Am J Med 2023; 136:1109-1118.e3. [PMID: 37572740 PMCID: PMC10592144 DOI: 10.1016/j.amjmed.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Right heart thrombus is a rare but serious form of venous thromboembolic disease that may be associated with pulmonary embolism. The prognosis of patients with right heart thrombus presenting without a concomitant pulmonary embolism remains ill-defined. METHODS We conducted a multi-center observational cohort study to compare patients presenting with right heart thrombus with and without a concurrent pulmonary embolism. The primary endpoint was 90-day all-cause mortality. Multivariable regression was utilized to assess primary and secondary outcomes. RESULTS Of 231 patients with right heart thrombus, 104 (45.0%) had a pulmonary embolism at admission. The median age of the cohort was 59.4 years (interquartile range 44.9-71.3). Pulmonary embolism in the setting of a right heart thrombus was associated with an increased adjusted hazard of 90-day mortality (hazard ratio 3.68; 95% confidence interval [CI], 1.51-8.97). Additionally, these patients had a higher adjusted risk of in-hospital mortality (odds ratio [OR] 2.55; 95% CI, 1.15-5.94) and admission to the intensive care unit (OR 2.45; 95% CI, 1.23-4.94). Thrombus mobility (OR 2.99; 95% CI, 1.35-6.78) and larger thrombus sizes (OR 1.04; 95% CI, 1.00-1.07) were associated with development of concurrent pulmonary embolism. CONCLUSIONS Patients with right heart thrombus and pulmonary embolism had a more severe clinical presentation, required more advanced therapies, and had reduced survival compared with those without a concomitant pulmonary embolism. Important variables associated with development of concomitant pulmonary embolism include thrombus mobility and size. Right heart thrombus in the setting of acute pulmonary embolism represents a unique clinical entity that is associated with worse prognosis compared with right heart thrombus only.
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Affiliation(s)
- Nathan W Watson
- Harvard Medical School, Boston, Mass; Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Ido Weinberg
- Harvard Medical School, Boston, Mass; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Andrew B Dicks
- Harvard Medical School, Boston, Mass; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Esmond Fong
- Harvard Medical School, Boston, Mass; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Jordan B Strom
- Harvard Medical School, Boston, Mass; Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass; Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Brett J Carroll
- Harvard Medical School, Boston, Mass; Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass; Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Aishwarya Raja
- Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Robert Schainfeld
- Harvard Medical School, Boston, Mass; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Eric A Secemsky
- Harvard Medical School, Boston, Mass; Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass; Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass.
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Li W, Liu Z, Chen X, Qian Y, Quan R, Xiong C, Gu Q, He J. Right heart thrombus in acute pulmonary embolism: A single center experience in China. Pulm Circ 2023; 13:e12291. [PMID: 37744669 PMCID: PMC10511828 DOI: 10.1002/pul2.12291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/22/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023] Open
Abstract
Right heart thrombus (RHT) is a rare but life-threatening condition in acute pulmonary embolism (APE) without clear management guidelines. This study aimed to address the clinical characteristics and outcomes of RHT-APE in Chinese patients. In this study, 17 RHT-APE and 329 non-RHT-APE patients, who were diagnosed between September 2015 and August 2019, were retrospectively recruited with the median follow-up was 360 days. The overall prevalence of RHT was 4.91% in APE. Its prevalence increased along the increase of APE risk stratifications. Comparisons showed that with higher proportion of male gender and younger age, RHT-APE patients also had worse hemodynamic instability and heart function, and higher risk stratification levels than non-RHT-APE patients. After adjusting by age and gender, multivariate logistic regression analysis found high/intermediate-high risk stratification, decreased right ventricular (RV) motion, NT-proBNP >600 pg/mL, and RV dysfunction were risk factors for RHT. Kaplan-Meier analysis showed non-RHT had better prognosis than RHT patients (30-day survival: log-rank: p < 0.001; 90-day survival: log-rank: p = 0.002). The multivariate logistic regression analysis showed RHT was an independent risk factor for 30-day mortality in APE. The subgroup analysis showed RHT would result in worse outcomes in patients who already had higher APE early mortality risk. RHT would increase the risk of 30- and 90-day mortality in APE. More attention should be paid to young male APE patients with decreased RV motion, NT-proBNP >600 pg/mL, RV dysfunction, or high level of risk stratification, to exclude the coexistence of RHT.
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Affiliation(s)
- Wen Li
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zhi‐Ying Liu
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xiao‐Xi Chen
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yu‐Ling Qian
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Rui‐Lin Quan
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Chang‐Ming Xiong
- State Key Laboratory of Cardiovascular Disease, Center of Pulmonary Vascular Disease, National Center for Cardiovascular Diseases, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Qing Gu
- State Key Laboratory of Cardiovascular Disease, Key Laboratory of Pulmonary Vascular Medicine, Emergency Center, National Center for Cardiovascular Diseases, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jian‐Guo He
- State Key Laboratory of Cardiovascular Disease, Center of Pulmonary Vascular Disease, National Center for Cardiovascular Diseases, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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Li Y, Wang X, Ren W, Xiao Y, Yu X, Tan X. Cardiac thrombotic stability determined by contrast-enhanced echocardiography: investigative protocol and preliminary results. BMC Cardiovasc Disord 2021; 21:267. [PMID: 34058996 PMCID: PMC8167997 DOI: 10.1186/s12872-021-02085-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/27/2021] [Indexed: 11/11/2022] Open
Abstract
Objective This study’s intent was to test a new system for scoring cardiac thrombotic stability, based on contrast-enhanced ultrasound (CEUS). Methods We used human whole blood for an in vitro thrombotic model involving 1-h (T1h) and 7-day (T7d) subsets. The T1h group was monitored for 1 h continuously to observe for the formation of a new thrombus on the original thrombus base. Changes in thrombotic CEUS images, histologic features, and shear wave elastography were recorded over time. We also studied 28 patients diagnosed with cardiac thrombi, each examined by transthoracic echocardiography and CEUS.Thrombi were scored for substrate (Ts) and hardness (Th) based on the visualized degree of contrast penetration into the thrombi. Statistical analyses of Ts and Th reflected thrombolytic time and risk of embolism to other organs. Results Histologically, the loosely constructed ends of in vitro thrombi solidified over time. In addition, the average Young’s modulus of thrombi over time indicated a progressive increase in hardness. Contrast-enhancing agents were able to penetrate fresh, loose thrombi only, not chronic, stable thrombi. As Ts and Th increased, prolonged thrombolytic time and greater risk of embolism to other organs were apparent. Conclusions Our data suggest that this new CEUS scoring system correlates well with cardiac thrombotic hardness and the quality of its underlying substrate, serving to quantify thrombotic stability.
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Affiliation(s)
- Ying Li
- Department of Ultrasound, Shengjing Hospital of China Medical University, No.36, Sanhao Street, Heping District, Shenyang City, 110004, China
| | - Xin Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, No.36, Sanhao Street, Heping District, Shenyang City, 110004, China.
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, No.36, Sanhao Street, Heping District, Shenyang City, 110004, China
| | - Yangjie Xiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, No.36, Sanhao Street, Heping District, Shenyang City, 110004, China
| | - Xiaona Yu
- Department of Ultrasound, Shengjing Hospital of China Medical University, No.36, Sanhao Street, Heping District, Shenyang City, 110004, China
| | - Xueying Tan
- Department of Ultrasound, Shengjing Hospital of China Medical University, No.36, Sanhao Street, Heping District, Shenyang City, 110004, China
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4
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Muramoto H, Niwa A, Satoh Y, Onishi T, Kobayashi I, Onishi Y, Harada N, Musha T. Clinical Significance and Prognosis of Right Heart Thrombi Associated With Acute Pulmonary Thromboembolism - Results of a Multicenter Registry of Thrombolysis in Japan. Circ J 2021; 85:353-360. [PMID: 33408303 DOI: 10.1253/circj.cj-20-0501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Thrombolytic therapy is standard treatment in acute pulmonary thromboembolism (PTE) with hemodynamic instability. Although right heart thrombi (RHT) appear to increase mortality in acute PTE, large-scale studies of acute PTE with RHT are scarce.Methods and Results:Patient data (from August 2005 to May 2014) obtained from post-marketing surveillance of thrombolytic therapy using a tissue-type plasminogen activator were analyzed retrospectively. Of the 2,698 confirmed cases of acute PTE who underwent echocardiographic assessment, 166 (6.2%) were diagnosed with RHT. PTE patients with RHT, compared with those without RHT, had higher rates of mortality (20.2% vs. 10.4%, P<0.001), hemodynamic instability (53.0% vs. 37.7%, P<0.001), and PTE recurrence (6.6% vs. 2.3%, P=0.003). When considering PTE-related hemodynamic severity (cardiopulmonary arrest/collapse, massive, submassive, and non-massive), mortality was significantly higher in patients with RHT in the massive (19.8% vs. 7.7%, P=0.002) and submassive (8.0% vs. 2.8%, P=0.018) groups, whereas no significant differences was found between those with and without RHT in the cardiopulmonary arrest/collapse (51.7% vs. 52.1%, P=0.960) and non-massive (1.6% vs. 0%, P=0.596) groups. CONCLUSIONS PTE patients with RHT had higher mortality, severity, and PTE recurrence rates. RHT was particularly associated with worse outcomes in patients with massive or submassive PTE.
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Affiliation(s)
| | - Akihiro Niwa
- Department of Cardiology, Hiratsuka Kyosai Hospital
| | | | | | | | - Yuko Onishi
- Department of Cardiology, Hiratsuka Kyosai Hospital
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5
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Abstract
Thrombus in transit (TIT) remains an uncommon diagnosis. However, it is often found in patients diagnosed with acute pulmonary embolism (PE). While thrombolytics are mainly used in life-threatening presentations, their role in stable patients with a known history of intracranial hemorrhage (ICH) is unclear.
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6
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Trombo en tránsito. Arch Bronconeumol 2020; 56:537-539. [DOI: 10.1016/j.arbres.2020.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/22/2020] [Accepted: 04/13/2020] [Indexed: 11/20/2022]
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7
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Worm in My Heart. Ann Am Thorac Soc 2020; 16:760-764. [PMID: 31149859 DOI: 10.1513/annalsats.201810-723cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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8
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Kabrhel C, Rosovsky R, Garvey S. Special Considerations in Pulmonary Embolism: Clot-in-Transit and Incidental Pulmonary Embolism. Crit Care Clin 2020; 36:531-546. [PMID: 32473697 DOI: 10.1016/j.ccc.2020.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This article describes 2 relatively rare, but complex situations in pulmonary embolism (PE): clot-in-transit (CIT), incidental PE (IPE). CIT describes a venous thromboembolism that has become lodged in the right heart. CIT is associated with high mortality and presents unique challenges in management. Incidental PE (IPE) describes PE diagnosed on imaging performed for another indication. The treatment is complex because there is often a disconnect between the PE severity on imaging and lack of severity of the clinical presentation. We summarize the available literature and aid clinicians as they manage patients with PE across the clinical severity spectrum.
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Affiliation(s)
- Christopher Kabrhel
- Department of Emergency Medicine, Center for Vascular Emergencies, Massachusetts General Hospital, Harvard Medical School, Zero Emerson Place, Suite 3B, Boston, MA 02114, USA.
| | - Rachel Rosovsky
- Division of Hematology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Shannon Garvey
- Boston University School of Medicine, 72 E Concord Street, Boston, MA 02118, USA
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9
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Lai E, Alishetti S, Wong JM, Delic L, Egrie G, Rosenblatt A. Right Ventricular Thrombus in Transit: Raising the Stakes in the Management of Pulmonary Embolism. ACTA ACUST UNITED AC 2019; 3:272-276. [PMID: 32002483 PMCID: PMC6984981 DOI: 10.1016/j.case.2019.05.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Right heart thrombi are rare and associated with significant mortality. RV thrombus was complicated by recurrent pulmonary emboli and managed surgically. Recurrent pulmonary emboli in anticoagulated patients may suggest malignancy. The optimal treatment for right heart thrombi remains uncertain. Surgical thrombectomy is an option, but treatment should be individualized.
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Affiliation(s)
- Everett Lai
- California Pacific Medical Center, San Francisco, California
| | | | - Jonathan M Wong
- California Pacific Medical Center, San Francisco, California
| | - Lejla Delic
- Department of Gynecologic Oncology, California Pacific Medical Center, San Francisco, California
| | - Glenn Egrie
- Department of Cardiothoracic Surgery, California Pacific Medical Center, San Francisco, California
| | - Andrew Rosenblatt
- Department of Cardiology, California Pacific Medical Center, San Francisco, California
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10
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Huang J, Shen D. Floating Mass Across the Tricuspid Valve. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:821-822. [PMID: 30121961 DOI: 10.1002/jum.14763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/20/2018] [Accepted: 06/22/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Jun Huang
- Department of Echocardiography Changzhou No. 2 People's Hospital, Affiliated with Nanjing Medical University, Changzhou, China
| | - Dan Shen
- Department of Echocardiography Changzhou No. 2 People's Hospital, Affiliated with Nanjing Medical University, Changzhou, China
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11
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Ahmed M, Montford JH, Lau E. Vacuum-assisted right atrial infected clot extraction due to persistent bacteraemia: a percutaneous approach for the management of right-sided endocarditis. BMJ Case Rep 2018; 2018:bcr-2018-226493. [PMID: 30181406 DOI: 10.1136/bcr-2018-226493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 56-year-old woman with non-ischaemic cardiomyopathy with implantable cardioverter defibrillator (ICD) presented to the hospital with progressive dyspnoea of 4 weeks' duration. She soon spiralled down to develop septic shock with methicillin-sensitive Staphylococcus aureus bacteraemia. A transoesophageal echocardiogram revealed a 2.4×2.1 cm large mobile echodensity in the right atrium likely attached to the ICD lead and to the interatrial septum. Although the ICD along with its leads was extracted, bacteraemia persisted despite appropriate antibiotic therapy. Because of her worsening condition, she underwent a right atrial infected clot extraction by the AngioVac system. Her clinical condition noticeably improved soon after evacuation of the infected clot.
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Affiliation(s)
- Mashrafi Ahmed
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, Illinois, USA
| | | | - Evan Lau
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, Illinois, USA
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12
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Letourneau MM, Wilczynski S, Rao S, Osman A. Two-for-One Saddles: A Case of Mobile Double Pulmonary Embolism. ACTA ACUST UNITED AC 2018; 2:66-68. [PMID: 30062313 PMCID: PMC6058394 DOI: 10.1016/j.case.2017.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Mobile main pulmonary artery emboli on transthoracic echocardiogram. Large saddle embolus with mobile component. Classic echocardiographic findings of massive pulmonary embolism. Complex treatment decision of high-mortality free-floating right heart thrombi.
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Affiliation(s)
- Marcel M Letourneau
- Department of Cardiovascular Medicine, Genesys Regional Medical Center, Grand Blanc, Michigan
| | - Sheri Wilczynski
- Department of Cardiovascular Medicine, Genesys Regional Medical Center, Grand Blanc, Michigan
| | - Sunilkumar Rao
- Department of Cardiovascular Medicine, Genesys Regional Medical Center, Grand Blanc, Michigan
| | - Abdulfatah Osman
- Department of Cardiovascular Medicine, Genesys Regional Medical Center, Grand Blanc, Michigan
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13
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Liu CW, Lee JK, Huang JH, Lin HH. Image Quiz: An Old Woman with a Fava-Bean in the Heart. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791402100311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- CW Liu
- Tri-service General Hospital, Division of Cardiology, Department of Medicine, Songshan Branch, No. 131, Jiankang Road, Songshan District, Taipei City 105, Taiwan
| | | | - JH Huang
- Far Eastern Memorial Hospital, Division of Cardiovascular Surgery, Cardiovascular Center, No.21, Sec. 2, Nanya S. Road, Banqiao District, New Taipei City, Taiwan
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Becattini C, Guglielmelli E, Floriani I, Morrone V, Caponi C, Pizzorno L, Masotti L, Bongarzoni A, Pignataro L, Casazza F. Prognostic significance of free-floating right heart thromboemboli in acute pulmonary embolism. Thromb Haemost 2017; 111:53-7. [DOI: 10.1160/th13-04-0303] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 08/28/2013] [Indexed: 11/05/2022]
Abstract
SummaryThe exact prevalence of mobile right heart thromboemboli (RHTh) in patients with pulmonary embolism (PE) is unknown, depending upon PE severity and the use of early echocardiography. Similarly, the mortality rate is variable, though RHTh detection appears to substantially increase the risk of death in patients with PE. The aim of this study was to assess the prevalence of RHTh in different risk categories in a wide series of patients with PE, and to analyse the effect of RHTh on in-hospital mortality. Among 1,716 patients enrolled in the Italian Pulmonary Embolism Registry, 1,275 (13.3% at high risk, 59.3% at intermediate risk and 27.4% at low risk) had echocardiography within 48 hours from hospital admission and entered the study. Overall, RHTh were detected in 57 patients (4.5%, at admission echocardiography in 88%): in 27/169 (16%) high-risk, in 29/756 (3.8%) intermediate-risk and 1/350 (0.3%) low-risk patients, respectively. At multivariate analysis, only advanced age (odds ratio [OR] 1.61, 95% confidence [CI] 1.27–2.03, p<0.0001), high-risk category (OR vs low-risk category 37.82, 95% CI 11.26–127.06, p<0.0001) and recurrent PE (OR 45.92, 95%CI 15.19–139.96, p<0.0001) showed a statistically significant effect on mortality. The presence of RHTh significantly increased the risk of dying (OR 3.89, 95%CI 1.98–7.67, p=0.0001) at univariate analysis, but this result was not mantained in the multivariate model (OR 1.64, 95%CI 0.75–3.60, p=0.216). In conclusion, though patients with RHTh had a more severe presentation of PE, this study did not detect an association between RHTh and prognosis.
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15
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Floating right heart thrombi: A pooled analysis of cases reported over the past 10years. Am J Emerg Med 2017; 36:911-915. [PMID: 29111332 DOI: 10.1016/j.ajem.2017.10.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/14/2017] [Accepted: 10/16/2017] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Floating right heart thrombi (FRHTS) are a rare phenomenon associated with high mortality. Immediate treatment is mandatory, but optimal therapy is controversial. OBJECTIVE To compare the clinical characteristics according to different treatment strategies and to identify predictors of mortality on patients with FRHTS. METHODS We conducted a systematic search of reported clinical cases of TTRH from 2006 to 2016. RESULTS 207 patients were analyzed, median age was 60years, 51.7% were men, 31.4% presented with shock. Pulmonary thromboembolism was present in 85% of the cases. The treatments administered were anticoagulation therapy in 44 patients (21.28%), surgical embolectomy in 89 patients (43%), thrombolytic therapy in 66 patients (31.8%), percutaneous thrombectomy in 3 patients (1.93%) and fibrinolytic in situ in 4 (1.45%). The overall mortality rate was 21.3%. The mortality associated with anticoagulation alone was higher than surgical embolectomy or thrombolysis (36.4 vs 18% vs 18.2%, respectively, p=0.03), and in percutaneous thrombectomy and fibrinolytics in situ was 0%. At multivariate analysis, only anticoagulation alone (odds ratio [OR] 2.4, IC 95% 1.07-5.4, p=0.03), and shock (OR 2.87 (IC 95% 1.3-5.9, p=0.005) showed a statistically significant effect on mortality. CONCLUSION FRHTS represent a serious form of thromboembolism that requires rapid decisions to improve the survival. Anticoagulation as the only strategy does not seem to be sufficient, while thrombolysis and surgical thrombectomy show better and similar results. A proper individualization of the risk and benefits of both techniques is necessary to choose the most appropriate strategy for our patients.
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16
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Esposito R, Santoro C, Sorrentino R, Alcidi G, De Roberto AM, Santoro A, Tufano A, Trimarco B, Galderisi M. The role of cardiovascular ultrasound in diagnosis and management of pulmonary embolism. Future Cardiol 2017; 13:465-477. [PMID: 28832194 DOI: 10.2217/fca-2017-0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The diagnosis of acute pulmonary embolism (PE) is one of the most important problems in medical emergencies. Commonly accepted criterion for diagnosis of deep venous thrombosis is the lack of vein compressibility assessed by Compression UltraSonography. Echocardiography represents an easily available and reliable imaging technique in the clinical setting of hemodynamic instability and in the direct visualization of thromboembolic masses in the right heart chambers. Moreover, echocardiography is useful for prognostic stratification after acute PE as right ventricular dysfunction is the most important predictor of mortality in this context. This review aims to highlight usefulness, potentialities and perspectives of standard and advanced echocardiography in evaluating patients affected by PE.
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Affiliation(s)
- Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Regina Sorrentino
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Gianmarco Alcidi
- Department of Clinical Medicine & Surgery, Federico II University Hospital, Naples, Italy
| | - Anna Maria De Roberto
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | | | - Antonella Tufano
- Department of Clinical Medicine & Surgery, Federico II University Hospital, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
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Português J, Calvo L, Oliveira M, Pereira VH, Guardado J, Lourenço MR, Azevedo O, Ferreira F, Canário-Almeida F, Lourenço A. Pulmonary Embolism and Intracardiac Type A Thrombus with an Unexpected Outcome. Case Rep Cardiol 2017; 2017:9092576. [PMID: 28469944 PMCID: PMC5392407 DOI: 10.1155/2017/9092576] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/23/2017] [Indexed: 11/18/2022] Open
Abstract
Detection of right heart thrombi (RHT) in the context of pulmonary thromboembolism (PE) is uncommon (4-18%) and increases the risk of mortality beyond the presence of PE alone. Type A thrombi are serpiginous and highly mobile and are thought to be originated from large veins and captured in-transit within the right heart. Optimal management of RHT is still uncertain. A 79-year-old woman, with a history of recent total hysterectomy with adnexectomy and a Wells procedure, presented to the emergency department following an episode of syncope. Computed tomography revealed bilateral PE and the presence of a right atrial thrombus. Transthoracic echocardiography demonstrated a free-floating type A thrombus in the right atrium, protruding into the right ventricle, and signs of pulmonary hypertension and right ventricle dysfunction. Considering the recent surgery and clinical stability, treatment with heparin alone was decided. Subsequent clinical improvement was observed and echocardiographic follow-up revealed complete thrombus dissolution and complete recovery of right ventricle function. Most authors recommend treatment of PE with RHT with thrombolysis or embolectomy followed by anticoagulation, although evidence is scarce. Individual risk of hemorrhage and operatory-related mortality should be taken into account when defining the treatment strategy especially when benefit is not firmly established.
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Affiliation(s)
- João Português
- Cardiology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Lucy Calvo
- Cardiology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Margarida Oliveira
- Cardiology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
| | | | - Joana Guardado
- Cardiology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Mário Rui Lourenço
- Cardiology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Olga Azevedo
- Cardiology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Francisco Ferreira
- Cardiology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
| | | | - António Lourenço
- Cardiology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
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18
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Thrombolytic therapy delay is independent predictor of mortality in acute pulmonary embolism at emergency service. Kaohsiung J Med Sci 2016; 32:572-578. [DOI: 10.1016/j.kjms.2016.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 09/13/2016] [Accepted: 09/20/2016] [Indexed: 11/18/2022] Open
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19
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Barrios D, Rosa-Salazar V, Morillo R, Nieto R, Fernández S, Zamorano JL, Monreal M, Torbicki A, Yusen RD, Jiménez D. Prognostic Significance of Right Heart Thrombi in Patients With Acute Symptomatic Pulmonary Embolism: Systematic Review and Meta-analysis. Chest 2016; 151:409-416. [PMID: 27746202 DOI: 10.1016/j.chest.2016.09.038] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/26/2016] [Accepted: 09/29/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND For patients diagnosed with acute pulmonary embolism (PE), the prognostic significance of concomitant right heart thrombi (RHT) lacks clarity. METHODS We performed a meta-analysis of studies that enrolled patients with acute PE to assess the prognostic value of echocardiography-detectable RHT for the primary outcome of short-term all-cause mortality and the secondary outcome of short-term PE-related mortality. Unrestricted searches were conducted of PubMed and Embase from 1980 through January 31, 2016, and used the terms "right heart thrombi," "pulmonary embolism," and "prognos.*" A random effects model was used to pool study results; Begg rank correlation method was used to evaluate for publication bias; and I2 testing was used to assess for heterogeneity. RESULTS Six of 79 potentially relevant studies met the inclusion criteria (15,220 patients). Overall, 99 of 593 patients with echocardiography-detectable RHT died (16.7% [95% CI, 13.8-19.9]) compared with 639 of 14,627 without RHT (4.4% [95% CI, 4.0-4.7]). RHT had a significant association with short-term all-cause mortality in all patients (OR, 3.0 [95% CI, 2.2 to 4.1]; I2 = 20%) and with PE-related death (three cohorts, 12,955 patients; OR: 4.8 [95% CI, 2.0-11.3; I2 = 76%). Results were consistent for the prospective (two cohorts, 514 patients; OR, 4.8 [95% CI, 1.7-13.6]; I2 = 56%) and the retrospective (four cohorts, 14,706 patients; OR, 2.8 [95% CI, 2.1 to 3.8]; I2 = 0%) studies. CONCLUSIONS In patients diagnosed with acute PE, concomitant RHT were significantly associated with an increased risk of death within 30 days of PE diagnosis. TRIAL REGISTRY PROSPERO registry; No.: CRD42016033960; URL: https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
- Deisy Barrios
- Respiratory Department, Ramón y Cajal Hospital, Universidad de Alcalá (IRYCIS), Madrid, Spain
| | - Vladimir Rosa-Salazar
- Department of Internal Medicine, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Raquel Morillo
- Respiratory Department, Ramón y Cajal Hospital, Universidad de Alcalá (IRYCIS), Madrid, Spain
| | - Rosa Nieto
- Respiratory Department, Ramón y Cajal Hospital, Universidad de Alcalá (IRYCIS), Madrid, Spain
| | - Sara Fernández
- Cardiology Department, Ramón y Cajal Hospital, Universidad de Alcalá (IRYCIS), Madrid, Spain
| | - José Luis Zamorano
- Cardiology Department, Ramón y Cajal Hospital, Universidad de Alcalá (IRYCIS), Madrid, Spain
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona and Universidad Católica de Murcia, Spain
| | - Adam Torbicki
- Department of Cardiovascular and Pulmonary Thromboembolic Diseases, European Health Centre, Otwock, Poland
| | - Roger D Yusen
- Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St. Louis, MO
| | - David Jiménez
- Respiratory Department, Ramón y Cajal Hospital, Universidad de Alcalá (IRYCIS), Madrid, Spain.
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20
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Athappan G, Sengodan P, Chacko P, Gandhi S. Comparative efficacy of different modalities for treatment of right heart thrombi in transit: a pooled analysis. Vasc Med 2016; 20:131-8. [PMID: 25832601 DOI: 10.1177/1358863x15569009] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective was to compare the efficacy of treatment options for right heart thrombi (RHT) in transit. All published reports between 1992 and 2013 were identified and pooled. We analyzed 328 patients with RHT and pulmonary embolism (PE). The treatments administered were none in 11 patients (3.4%), anticoagulation (AC) with heparin in 70 patients (21.3%), thrombolytics in 122 patients (37.2%), catheter-related treatments in five patients (1.5%) and surgical embolectomy in 120 patients (36.6%). The overall short-term mortality for the entire cohort was 23.2%. The mortality rate associated with no therapy was highest at 90.9%. The mortality associated with AC alone was significantly higher than surgical embolectomy or thrombolysis (37.1% vs 18.3% vs 13.7%, respectively). In univariate analysis, any therapy was better than no therapy with a favorable odds of 16.92 (95% CI 2.05-139.87) for AC, 61.76 (95% CI 7.42-513.81) for thrombolysis and 44.54 (95% CI 5.42-366.32) for surgical embolectomy. In multivariate analysis with age and hemodynamic status entered as covariates, thrombolytic therapy was better than AC with favorable odds of 4.83 (95% CI 1.52-15.36). Similarly, there was a trend in favor of surgical embolectomy with an odds of 2.61 (95% CI 0.90-7.58). The estimated probability of survival in hemodynamically unstable patients with AC, surgical embolectomy and thrombolysis was 47.7%, 70.45% and 81.5%, respectively. There was no significantly increased risk of complications with thrombolytic therapy. In conclusion, left untreated, patients with RHT and PE have very high mortality. Aggressive management with thrombolysis or surgical thrombectomy may be more effective than AC alone in the management of these patients.
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Affiliation(s)
- Ganesh Athappan
- Department of Cardiovascular Medicine, Heart & Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | - Prasanna Sengodan
- Department of Cardiovascular Medicine, Heart & Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | - Paul Chacko
- Department of Cardiovascular Medicine, Heart & Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sanjay Gandhi
- Department of Cardiovascular Medicine, Heart & Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
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21
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Brault-Meslin O, Mazouz S, Nallet O, Cattan S, Amara W. [Free floating thrombus in right cardiac chambers and thrombolysis]. Ann Cardiol Angeiol (Paris) 2015; 64:410-413. [PMID: 26482630 DOI: 10.1016/j.ancard.2015.09.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 09/03/2015] [Indexed: 06/05/2023]
Abstract
Free-floating thrombi in the right heart chambers is a rare phenomenon. Nearly 99% of detected cases are associated with the presence of proven pulmonary embolism. Its presence is associated with a poor outcome with a mortality between 27 to 44% according to studies. Despite the emergency of treatment, optimal management of free floating right heart thrombus remains controversial with no clear consensus. We present the case of a 84-year-old man hospitalised for acute decompensated heart failure. After an initial favourable evolution, a degradation of respiratory occurred with dyspnea and desaturation. A bedside transthoracic echocardiography showed a mobile serpiginous thrombus, 7cm size, moving to and across the tricuspid valve. A computed tomography of the chest demonstrated massive bilateral pulmonary embolism. After persistence of the thrombus and seven days of heparinotherapy, thrombolysis therapy was initiated. The thrombus disappeared 24h after thrombolysis. Without contra-indication, thrombolysis is a faster, readily available treatment for the management of floating thrombus in the right heart chambers associated with pulmonary embolism.
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Affiliation(s)
- O Brault-Meslin
- Service de cardiologie, GHI Le Raincy-Montfermeil, 10, rue du Gl-Leclerc, 93370 Montfermeil, France
| | - S Mazouz
- Service de cardiologie, GHI Le Raincy-Montfermeil, 10, rue du Gl-Leclerc, 93370 Montfermeil, France
| | - O Nallet
- Service de cardiologie, GHI Le Raincy-Montfermeil, 10, rue du Gl-Leclerc, 93370 Montfermeil, France
| | - S Cattan
- Service de cardiologie, GHI Le Raincy-Montfermeil, 10, rue du Gl-Leclerc, 93370 Montfermeil, France
| | - W Amara
- Service de cardiologie, GHI Le Raincy-Montfermeil, 10, rue du Gl-Leclerc, 93370 Montfermeil, France.
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22
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Gbolahan OB, Stankowski-Drengler TJ, Ibraheem A, Engel JM, Onitilo AA. Management of chemotherapy-induced thromboembolism in breast cancer. BREAST CANCER MANAGEMENT 2015. [DOI: 10.2217/bmt.15.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Thromboembolic events are common in cancer patients and, apart from contributing to significant morbidity, are regarded as the second leading cause of death in this population. Breast cancer patients are considered low risk for venous thromboembolism; however, the presence of advanced disease and use of chemotherapy and/or other adjunct treatments significantly raises this risk by altering the balance of pro- and anti-coagulant proteins. Low molecular weight heparin is central to the management of venous thromboembolism in this context, whether for prophylaxis, acute management or prevention of recurrences. Risk stratification models need to be incorporated to guide decision making where available.
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Affiliation(s)
- Olumide B Gbolahan
- Morehouse school of Medicine, 720 Westview Drive SW, Atlanta, GA 30310, USA
| | | | - Abiola Ibraheem
- Morehouse school of Medicine, 720 Westview Drive SW, Atlanta, GA 30310, USA
| | - Jessica M Engel
- Marshfield Clinic Cancer Care at St Michael's, Stevens Point, WI, USA
| | - Adedayo A Onitilo
- Oncology/Hematology Department, Marshfield Clinic Weston Center, Weston, WI, USA
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23
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Donaldson CW, Baker JN, Narayan RL, Provias TS, Rassi AN, Giri JS, Sakhuja R, Weinberg I, Jaff MR, Rosenfield K. Thrombectomy using suction filtration and veno-venous bypass: single center experience with a novel device. Catheter Cardiovasc Interv 2015; 86:E81-7. [PMID: 24975395 DOI: 10.1002/ccd.25583] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 06/22/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To describe the first single center experience with a novel aspiration thrombectomy device. BACKGROUND The appearance of inferior vena cava or right-sided intracardiac thrombus may prompt consideration of percutaneous thrombectomy as a method to prevent new or worsening pulmonary embolism (PE). The AngioVac is a novel thrombectomy device composed of a cannula and extracorporeal circuit with filter for pump-assisted removal of intravascular debris which is coupled with a reinfusion catheter for return of blood to the patient. The device has been approved by the United States Food and Drug Administration since 2009. This report represents the first significant case series describing its use, feasibility and outcomes in evacuating large caval thrombi or intracardiac masses in PE. METHODS This is a retrospective analysis of patient and case characteristics and in-hospital clinical outcomes of AngioVac thrombectomy in 14 consecutive patients treated between April 2010 and July 2013 at our institution. RESULTS Fourteen consecutive patients (mean age 50, 64% female) underwent 15 AngioVac procedures over 40 months. Indications included intracardiac mass (73%), acute PE (33%), and caval thrombus (73%). Four patients (27%) were in shock at the start of the procedure. Peri-procedure mortality was 0% and in-hospital mortality was 13% at a mean follow-up of 23 days. There were no pulmonary hemorrhages, strokes or myocardial infarctions. Though 73% had a post procedural drop in hematocrit, only two bleeding events were related to access site and required a transfusion. CONCLUSIONS AngioVac thrombectomy is feasible in critically ill patients with acute DVT or PE and large caval thrombi or intracardiac masses.
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Affiliation(s)
- Cameron W Donaldson
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joshua N Baker
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rajeev L Narayan
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tim S Provias
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew N Rassi
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jay S Giri
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Rahul Sakhuja
- Cardiovascular Medicine/Intervention and Structural Heart Disease, Wellmont CVA Heart Institute, Kingsport, Tennessee
| | - Ido Weinberg
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael R Jaff
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kenneth Rosenfield
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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24
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Free Floating Right Heart Thrombus Associated with Acute Pulmonary Embolism: An Unsettled Therapeutic Difficulty. Case Rep Cardiol 2015; 2015:364780. [PMID: 26078887 PMCID: PMC4442267 DOI: 10.1155/2015/364780] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 04/18/2015] [Indexed: 11/18/2022] Open
Abstract
Free floating right heart thrombus is a rare phenomenon in the context of acute pulmonary embolism and it is associated with a poor outcome. The increased use of echocardiography has led to an increased detection of right heart thrombi. However, optimal management of free floating right heart thrombus remains controversial with no clear consensus. We present the case of a 74-year-old woman who presented to the emergency department with acute onset dyspnea on minimal exertion which had developed over a period of 1 day. A computed tomography of the chest demonstrated massive bilateral proximal pulmonary embolism. A bedside transthoracic echocardiography performed showed a moderately dilated, poorly functioning right ventricle with visible highly mobile serpiginous thrombus moving to and fro across the tricuspid valve. Thrombolytic therapy was immediately initiated with tenecteplase which resulted in excellent results. Although there is no clear consensus for the management of right heart thrombus associated with pulmonary embolism, thrombolysis is readily available and can be effective in carefully selected patients.
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25
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Nam SB, Kim CM, Cho SA, Chung S, Shim YH. Thrombus entrapped by patent foramen ovale in a patient with pulmonary embolism: a case report. Korean J Anesthesiol 2015; 68:70-3. [PMID: 25664158 PMCID: PMC4318868 DOI: 10.4097/kjae.2015.68.1.70] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 02/17/2014] [Accepted: 03/27/2014] [Indexed: 11/26/2022] Open
Abstract
Thrombus-in-transit appears to increase the risk of mortality compared to pulmonary embolism alone and can require alteration in therapeutic plan. We present the case of a biatrial thromboembolus caught in transit across a patent foramen ovale diagnosed by intraoperative transesophageal echocardiogram in a 69-year-old female with acute pulmonary embolism and subsequent acute cerebral infarction. We suggest that echocardiography should be performed in a patient with suspected pulmonary thromboembolism to evaluate right heart function and diagnose emboli in transit.
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Affiliation(s)
- Sang Beom Nam
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Chan Mi Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Ah Cho
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sungchan Chung
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yon Hee Shim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
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26
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Temtanakitpaisan Y, Mahatanan R, Rishikof DC, Young DZ. Use of heparin alone in treating pulmonary emboli found in association with in-transit right-heart thrombi in a nonagenarian. Tex Heart Inst J 2013; 40:487-488. [PMID: 24082387 PMCID: PMC3783120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In patients who present with pulmonary embolism, right-heart thrombus is a rare condition that is associated with increased mortality rates, compared with pulmonary embolism alone. Thrombolytic therapy has been associated with a survival benefit in previous studies of pulmonary embolism arising from right-heart thrombus. However, older patients have been excluded from such studies because thrombolysis places them at excessively high risk of bleeding. We present a case, in a 92-year-old woman, of pulmonary embolism arising from right-heart thrombi that we successfully treated with heparin.
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Affiliation(s)
- Yutthapong Temtanakitpaisan
- Departments of Internal Medicine (Drs. Mahatanan and Temtanakitpaisan), Pulmonary and Critical Care (Dr. Rishikof), and Cardiology (Dr. Young), MetroWest Medical Center, Framingham, Massachusetts 01702
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27
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Bai W, Li H, Zhang Q, Rao L. Assessment right atrial thrombus by real-time three dimensional transthoracic echocardiography in patient with dilated cardiomyopathy. Cardiovasc Ultrasound 2011; 9:12. [PMID: 21477357 PMCID: PMC3090317 DOI: 10.1186/1476-7120-9-12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Accepted: 04/10/2011] [Indexed: 02/05/2023] Open
Abstract
We report a case of a 52-year-old patient with dilated cardiomyopathy who presented with worsening heart failure. Two-dimensional transthoracic echocardiography and real-time three dimensional transthoracic echocardiography showed severe dilated cardiac chambers, impaired ejection fraction and a mobile right atrial thrombus 2.6 × 1.0 cm in size, traversing the right atrial cavity during the whole cardiac cycle. After one week therapeutic anticoagulation, echocardiography confirmed no evidence of residual thrombus.
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Affiliation(s)
- Wenjuan Bai
- Echo Lab, Division of Cardiology Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
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