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Lahmidi I, Assoweh CD, Haddiya I, Bentata Y, Ouafi NE, Ismaili N. Clinicopathological features of adult right-sided cardiac masses: Analysis of 19 cases. Ann Med Surg (Lond) 2022; 77:103613. [PMID: 35638074 PMCID: PMC9142628 DOI: 10.1016/j.amsu.2022.103613] [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] [Received: 02/16/2022] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/22/2022] Open
Abstract
Background Right sided cardiac masses are rare. The purpose of this study is to review the clinical experience and pathological characteristics of right-sided cardiac masses and to provide a prognostic analysis in our hospital. Methods We retrospectively reviewed 19 consecutive cases of right heart masses diagnosed in our institution from 2016 to February 2020. All available clinicopathological features, imaging characteristics and disease outcomes were summarized and presented. Results The subjects included 9 men and 10 women with a mean age of 48.5 years. The most frequent complaint was dyspnea. The most common site was the right atrium (42.1%) followed by the tricuspid valve (36.8%). Clinical diagnosis revealed vegetations in 8 patients (42.1%), thrombi in 7 patients (36.8%), myxoma in 1 patient, hydatid cyst in 1 patient and metastatic (secondary) masse was seen in 2 cases. In the 19 patients, 3 patients underwent surgery, 15 patients were managed with medical treatment, therapeutic abstention was indicated in one patient. 14 patients were all alive at the end of the follow-up period. In contrast, 5 patients were dead (26.3%). Conclusion In our series, the majority of right cardiac masses were benign, outnumbering the malignant ones, as described in the literature. The mortality rate was relatively high about 26.3%.
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Affiliation(s)
- I Lahmidi
- Department of Cardiology, Laboratory of Epidemiology, Clinical Research and Public Health, Medical School, University Mohammed the First, Oujda, Morocco
| | - C Darar Assoweh
- Department of Cardiology, Laboratory of Epidemiology, Clinical Research and Public Health, Medical School, University Mohammed the First, Oujda, Morocco
| | - I Haddiya
- Department of Nephrology, Laboratory of Epidemiology, Clinical Research and Public Health, Medical School, University Mohammed the First, Oujda, Morocco
| | - Y Bentata
- Department of Nephrology, Laboratory of Epidemiology, Clinical Research and Public Health, Medical School, University Mohammed the First, Oujda, Morocco
| | - N El Ouafi
- Department of Cardiology, Laboratory of Epidemiology, Clinical Research and Public Health, Medical School, University Mohammed the First, Oujda, Morocco
| | - N Ismaili
- Department of Cardiology, Laboratory of Epidemiology, Clinical Research and Public Health, Medical School, University Mohammed the First, Oujda, Morocco
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Lio KU, Jiménez D, Moores L, Rali P. Clinical conundrum: concomitant high-risk pulmonary embolism and acute ischemic stroke. Emerg Radiol 2020; 27:433-439. [PMID: 32211984 DOI: 10.1007/s10140-020-01772-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/13/2020] [Indexed: 01/01/2023]
Abstract
High-risk PE can be complicated by the presence of a patent foramen ovale (PFO), which can lead to paradoxical systemic embolization, including cerebral embolism ultimately leading to acute ischemic stroke (AIS). Acute management is challenging given the competing benefits and risks of systemic thrombolysis. Herein, we aim to provide a review of clinical presentations, diagnostic findings, and treatment and outcome from the available literature, with the hopes of providing insight into treatment options. We followed the guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic literature search using PubMed/MEDLINE database, Cochrane Library, and Google Scholar for all reported cases/case series of concomitant high-risk PE and paradoxical ischemic stroke was conducted from inception to July 2019. Twenty-nine cases from 27 articles (26 single case reports, 1 case series of 3 patients) were included. There were 10 men and 19 women, ranging in age from 29 to 81 years (mean 56.1 ± 13.5 years). PFO was diagnosed in 89.7% of patients, mostly by transesophageal echocardiography. Treatment modalities included systemic thrombolysis (40%), anticoagulation alone (36%), surgical thrombectomy (16%), and percutaneous thrombectomy (8%). Overall mortality rate was 31%. Patients receiving thrombolysis and surgical thrombectomy had the most favorable outcome. Survival to discharge was 90% (9 out of 10), 100% (5 out of 5), and 50% (4 out of 8) in the systemic thrombolysis, surgical thrombectomy, and anticoagulation alone groups respectively. In the setting of combined high-risk PE and ischemic stroke, PFO can be detected in 90% of published cases. Thrombolysis and surgical thrombectomy seem to be effective management, but further studies are needed for validation.
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Affiliation(s)
- Ka U Lio
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - David Jiménez
- Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcala, Madrid, Spain
| | - Lisa Moores
- Department of Medicine, F. Edward Hebert School of Medicine, The Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Parth Rali
- Department of Thoracic Medicine and Surgery, Lewis Katz School Of Medicine, Temple University Hospital, Philadelphia, PA, USA.
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Noheria A, Ponamgi SP, Desimone CV, Vaidya VR, Aakre CA, Ebrille E, Hu T, Hodge DO, Slusser JP, Ammash NM, Bruce CJ, Rabinstein AA, Friedman PA, Asirvatham SJ. Pulmonary embolism in patients with transvenous cardiac implantable electronic device leads. Europace 2015; 18:246-52. [PMID: 25767086 DOI: 10.1093/europace/euv038] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 02/02/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cardiac implantable electronic devices (CIEDs) are commonly associated with transvenous lead-related thrombi that can cause pulmonary embolism (PE). METHODS AND RESULTS We retrospectively evaluated all patients with transvenous CIED leads implanted at Mayo Clinic Rochester between 1 January 2000, and 25 October 2010. Pulmonary embolism outcomes during follow-up were screened using diagnosis codes and confirmed with imaging study reports. Of 5646 CIED patients (age 67.3 ± 16.3 years, 64% men, mean follow-up 4.69 years) 88 developed PE (1.6%), incidence 3.32 [95% confidence interval (CI) 2.68-4.07] per 1000 person-years [men: 3.04 (95% CI 2.29-3.96) per 1000 person-years; women: 3.81 (95% CI 2.72-5.20) per 1000 person-years]. Other than transvenous CIED lead(s), 84% had another established risk factor for PE such as deep vein thrombosis (28%), recent surgery (27%), malignancy (25%), or prior history of venous thromboembolism (15%). At the time of PE, 22% had been hospitalized for ≥ 48 h, and 59% had been hospitalized in the preceding 30 days. Pulmonary embolism occurred in 22% despite being on systemic anticoagulation therapy. Out of 88 patients with PE, 45 subsequently died, mortality rate 93 (95% CI 67-123) per 1000 person-years (hazard ratio 2.0, 95% CI 1.5-2.7, P < 0.0001). CONCLUSIONS Though lead-related thrombus is commonly seen in patients with transvenous CIED leads, clinical PE occurs with a low incidence. It is possible that embolism of lead thrombus is uncommon or emboli are too small to cause consequential pulmonary infarction.
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Affiliation(s)
- Amit Noheria
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Shiva P Ponamgi
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA
| | - Christopher V Desimone
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | | | | | - Elisa Ebrille
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Joshua P Slusser
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Naser M Ammash
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Charles J Bruce
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | | | - Paul A Friedman
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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Nishigawa K, Takiuchi H, Kubo H, Tanemoto K. Triple-chamber cardiac thrombosis in a patient with atrial fibrillation and severe left ventricular dysfunction. Circ J 2011; 75:2908-9. [PMID: 21828929 DOI: 10.1253/circj.cj-11-0496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kosaku Nishigawa
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Japan.
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Amankwah KS, Seymour K, Costanza MJ, Gahtan V. Ultrasound accelerated catheter directed thrombolysis for pulmonary embolus and right heart thrombus secondary to transvenous pacing wires. Vasc Endovascular Surg 2011; 45:299-302. [PMID: 21278170 DOI: 10.1177/1538574410395040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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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Affiliation(s)
- Kwame S Amankwah
- Division of Vascular Surgery and Endovascular Services, SUNY Upstate Medical University, Syracuse, NY 13206, USA.
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