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Ahmed M, Solela G. Thrombus in transit associated with fatal pulmonary thromboembolism in an elderly Ethiopian man following a surgical procedure: A case report. Clin Case Rep 2024; 12:e9293. [PMID: 39130812 PMCID: PMC11310411 DOI: 10.1002/ccr3.9293] [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: 02/21/2024] [Revised: 07/02/2024] [Accepted: 07/13/2024] [Indexed: 08/13/2024] Open
Abstract
Key Clinical Message Early detection, timely management, and exploration of alternative treatment options are crucial for patients with high-risk pulmonary thromboembolism, particularly those with thrombus in transit. Furthermore, prophylactic measures against thromboembolic events should be highly considered for patients with predisposing conditions for venous thromboembolism, including surgical procedures. Abstract A thrombus in transit refers to a thrombus that is temporarily lodged in the right-side chambers of the heart with a high risk of embolization to the pulmonary artery. A 75-year-old man presented to the emergency department with a sudden onset of retrosternal chest pain for an hour associated with shortness of breath, which developed a week after transurethral resection of the prostate was done for the indication of benign prostatic hyperplasia. The physical examination was remarkable for tachycardia, tachypnea, hypoxia, and raised jugular venous pressure. Echocardiography revealed a serpiginous echogenic density in the right atrium, protruding through the tricuspid valve and extending to the right ventricle. He was put on facemask oxygen, and he received anticoagulation with unfractionated heparin, followed by thrombolytic therapy with streptokinase. However, the patient experienced cardiac arrest during the administration of thrombolytic therapy, and he died despite all the efforts, most likely due to a massive pulmonary thromboembolism resulting from the thrombus in transit. This case report has brought attention to the rare occurrence of a thrombus in transit complicated by fatal pulmonary thromboembolism. It has also highlighted the significant mortality risk that this condition carries, even with thrombolytic therapy.
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Affiliation(s)
- Mohammed Ahmed
- Department of Internal MedicineEthiotebib General HospitalAddis AbabaEthiopia
| | - Gashaw Solela
- Department of Internal MedicineYekatit 12 Hospital Medical CollegeAddis AbabaEthiopia
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2
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Buda K, Jensen J, Knickelbine T, Gebhard T, Engstrom B, Saxena R. Aspiration Thrombectomy for Intermediate-Risk Pulmonary Embolism. CJC Open 2024; 6:1021-1024. [PMID: 39211759 PMCID: PMC11357774 DOI: 10.1016/j.cjco.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/25/2024] [Indexed: 09/04/2024] Open
Affiliation(s)
- Kevin Buda
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA
- Cardiology Division, Department of Internal Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Joseph Jensen
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA
- Cardiology Division, Department of Internal Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | | | - Thomas Gebhard
- Department of Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bjorn Engstrom
- Department of Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Retu Saxena
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA
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3
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Bandari V, Gaddameedi SR, Faisal S, Singh A, Ghatala MZ, Singh M, Shah SM. The Management of Intracardiac Thrombus in a COVID-19 Patient Using IV Thrombolytics: A Case Report. Cureus 2024; 16:e64085. [PMID: 38979027 PMCID: PMC11229767 DOI: 10.7759/cureus.64085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2024] [Indexed: 07/10/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has unveiled numerous clinical challenges, particularly its association with thrombotic events, which significantly contribute to morbidity and mortality. While thrombotic complications such as arterial and venous thromboembolism (VTE) are well-documented, instances of intracardiac thrombus are notably rare. This case report discusses a 60-year-old male with COVID-19 who came to the hospital due to respiratory distress. Despite treatment with remdesivir, the patient's condition worsened prompting further workup. His nuclear medicine (NM) ventilation-perfusion scan was inconclusive, but a 2D echocardiogram showed an intracardiac thrombus in the right atrium (RA) and right ventricle (RV). As the patient's condition worsened, necessitating a transition from nasal cannula to high-flow nasal cannula, a decision was made to treat him with intravenous (IV) thrombolytic therapy. The patient received 100 mg IV alteplase and IV heparin, resulting in significant respiratory improvement and symptomatic relief. A repeat echocardiogram after 48 hours showed normal ejection fraction and complete thrombus resolution. In conclusion, this case highlights the complex link between COVID-19 infection and prothrombotic states, leading to severe complications such as intracardiac thrombus in transit. The successful treatment of this patient through a multidisciplinary approach and thrombolytic therapy underscores the importance of prompt recognition and intervention in high-risk cases.
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Affiliation(s)
| | | | - Shaji Faisal
- Internal Medicine, Gandhi Medical College, Secunderabad, IND
| | - Ashmin Singh
- Internal Medicine, Bayhealth Medical Center, Dover, USA
| | | | | | - Shazia M Shah
- Internal Medicine, Rutgers Health/Monmouth Medical Center, Long Branch, USA
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4
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Birrenkott DA, Kabrhel C, Dudzinski DM. Intermediate-Risk and High-Risk Pulmonary Embolism: Recognition and Management: Cardiology Clinics: Cardiac Emergencies. Cardiol Clin 2024; 42:215-235. [PMID: 38631791 DOI: 10.1016/j.ccl.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Pulmonary embolism (PE) is the third most common cause of cardiovascular death. Every specialty of medical practitioner will encounter PE in their patients, and should be prepared to employ contemporary strategies for diagnosis and initial risk-stratification. Treatment of PE is based on risk-stratification, with anticoagulation for all patients, and advanced modalities including systemic thrombolysis, catheter-directed therapies, and mechanical circulatory supports utilized in a manner paralleling PE severity and clinical context.
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Affiliation(s)
- Drew A Birrenkott
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Center for Vascular Emergencies, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Christopher Kabrhel
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Center for Vascular Emergencies, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - David M Dudzinski
- Center for Vascular Emergencies, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Cardiac Intensive Care Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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5
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Watson NW, Weinberg I, Dicks AB, Carroll BJ, Secemsky EA. Clinical Outcomes and Predictors of Advanced Therapy for the Management of Right Heart Thrombus. Circ Cardiovasc Interv 2024; 17:e013637. [PMID: 38410989 PMCID: PMC11021139 DOI: 10.1161/circinterventions.123.013637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/26/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND The role of advanced therapies (systemic thrombolysis, catheter-based treatment, and surgical thrombectomy) for the management of right heart thrombus is poorly defined. In this study, we assessed the clinical predictors and outcomes of advanced therapy compared with anticoagulation alone for the acute management of right heart thrombus. METHODS In this observational cohort study, we analyzed consecutive patients who were treated for right heart thrombus. The primary end point was 90-day all-cause mortality. Clinical predictors of utilizing advanced therapy were assessed with multivariable logistic regression. Propensity score matching was utilized to compare adjusted outcomes between patients receiving advanced therapies versus anticoagulation alone. RESULTS A total of 345 patients were included in the study. Advanced therapy was utilized in 13.6% (N=47) of patients, of which 25.5% (N=12/47) was systemic thrombolysis, 23.4% (N=11/47) was endovascular thrombectomy, and 53.2% (N=25/47) was surgical thrombectomy. Younger age (odds ratio, 0.98 [95% CI, 0.96-0.99]) and concurrent pulmonary embolism (odds ratio, 5.36 [95% CI, 2.48-12.1]) predicted utilization of advanced therapy. In propensity score-matched analysis, there was no difference in 90-day mortality (hazard ratio, 0.46 [95% CI, 0.17-1.22]), in-hospital mortality (odds ratio, 0.64 [95% CI, 0.17-2.19]), or length of stay (β, -4.39 [95% CI, -14.0 to 5.22]) between advanced therapy and anticoagulation. CONCLUSIONS Among a diverse cohort of patients with right heart thrombus, outcomes did not differ between those who underwent advanced therapy and anticoagulation alone. Important predictors for utilizing advanced treatment included younger age and the presence of a concurrent pulmonary embolism. Future studies assessing advanced therapy in larger and broader patient populations are necessary.
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Affiliation(s)
- Nathan W. Watson
- Harvard Medical School, Boston, MA
- Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Ido Weinberg
- Harvard Medical School, Boston, MA
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Andrew B. Dicks
- Department of Vascular Surgery, Prisma Health/University of South Carolina School of Medicine – Greenville, Greenville, SC
| | - Brett J. Carroll
- Harvard Medical School, Boston, MA
- Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Eric A. Secemsky
- Harvard Medical School, Boston, MA
- Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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6
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Hoffer M, Aziz S, Boniface K, Aziz JE, Pourmand A. A case report of point-of-care ultrasound directed thrombectomy: a reversible cause of cardiac arrest managed with extracorporeal membrane oxygenation cannulation. Clin Exp Emerg Med 2024; 11:100-105. [PMID: 38018071 PMCID: PMC11009710 DOI: 10.15441/ceem.23.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/02/2023] [Indexed: 11/30/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) has been increasingly employed in the emergency department for patients with a potentially reversible cause of cardiac arrest. We present the case of a young female patient with an in-hospital cardiac arrest who was found to have severe right heart strain on point-of-care ultrasound (POCUS), suggesting a massive pulmonary embolism. Rapid bedside diagnosis using ultrasound expedited bedside cannulation and initiation of ECMO as a bridge to surgical thrombectomy, and ultimately the patient survived with full neurologic function. With its ready availability and increasing acceptance by consultants, POCUS should be incorporated into cardiac arrest algorithms as the standard of care to rule in thrombotic and obstructive causes of cardiac arrest.
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Affiliation(s)
- Megan Hoffer
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Salim Aziz
- Division of Cardiac Surgery, George Washington University Hospital, Washington, DC, USA
| | - Keith Boniface
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Jenna E Aziz
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ali Pourmand
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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7
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Roy R, Guile B, Sun D, Szasz T, Singulane CC, Nguyen D, Abutaleb A, Lang RM, Addetia K. Right Ventricular Thrombus on Echocardiography. Am J Cardiol 2024; 211:64-68. [PMID: 37918474 DOI: 10.1016/j.amjcard.2023.10.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/30/2023] [Accepted: 10/28/2023] [Indexed: 11/04/2023]
Abstract
Right ventricular thrombi (RVTs) have been almost exclusively studied in patients with pulmonary embolism (PE). The implications of an isolated RVT, a finding typically encountered on transthoracic echocardiography (TTE), are lacking. In this study, we sought to identify the echocardiographic and clinical features associated with the presence of RVTs. Between 1998 and 2023, 138 patients with RVT documented on TTE were retrospectively identified. Demographic data, presence of intracardiac devices, hypercoagulable conditions, history of deep vein thrombosis (DVT), PE, and/or left ventricular thrombus were abstracted from electronic chart review. Measurements of right and left ventricular size, and function were performed on TTE. Of the total population of patients with RVT, <1/2 had intracardiac devices, 29% had a documented hypercoagulable state (e.g., cancer or a clotting disorder). Most patients had dilated (77%) and dysfunctional (72%) right ventricles. Approximately 50% of RVTs were discovered in nonstandard imaging planes, suggesting that the presence of RVT is likely underestimated in clinical practice. Of those evaluated for PE, 80% had PE. Of those evaluated for DVT, 53% had DVT. In conclusion, further investigations are warranted to better guide when to investigate the right ventricle for RVTs on TTE and the impact of RVTs on patient outcomes.
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Affiliation(s)
- Rukmini Roy
- Section of Cardiology, Heart and Vascular Center, University of Chicago, Chicago, Illinois
| | - Brittney Guile
- Section of Cardiology, Heart and Vascular Center, University of Chicago, Chicago, Illinois
| | - Deyu Sun
- Section of Cardiology, Heart and Vascular Center, University of Chicago, Chicago, Illinois
| | - Teodora Szasz
- Section of Cardiology, Heart and Vascular Center, University of Chicago, Chicago, Illinois
| | - Cristiane C Singulane
- Section of Cardiology, Heart and Vascular Center, University of Chicago, Chicago, Illinois
| | - Denis Nguyen
- Section of Cardiology, Heart and Vascular Center, University of Chicago, Chicago, Illinois
| | - Abdulrahman Abutaleb
- Section of Cardiology, Heart and Vascular Center, University of Chicago, Chicago, Illinois
| | - Roberto M Lang
- Section of Cardiology, Heart and Vascular Center, University of Chicago, Chicago, Illinois
| | - Karima Addetia
- Section of Cardiology, Heart and Vascular Center, University of Chicago, Chicago, Illinois.
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8
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Rao R, Aladamat N, Robbins S, Jumaa M, Zaidi S. Stroke Thrombectomy and Right Atrial Clot Aspiration in 29 Year Old Woman. Neurohospitalist 2024; 14:95-98. [PMID: 38235021 PMCID: PMC10790615 DOI: 10.1177/19418744231200052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
We present a case report of a previously healthy 29 year old woman who developed thromboembolic events in rapid fashion after a recent orthopedic surgery. This case highlights the importance of understanding risk factors for clot formation even in those who had no prior events, the efficacy of novel aspiration techniques to remove emboli, and how rapid triaging of acute symptoms can lead to the best outcomes. She presented to the emergency department with shortness of breath and was found to have a large bilateral pulmonary embolus. She was given intravenous thrombolysis. Shortly after, she developed aphasia and right-sided weakness and was taken emergently for mechanical thrombectomy of a left middle cerebral artery occlusion. She was later found to have a patent foramen ovale and a highly mobile right atrial thrombus which was aspirated. Further evaluation revealed right lower extremity peroneal and popliteal deep venous thrombi. She was placed on anticoagulation, made a full clinical recovery, and was discharged home. Prompt recognition of symptoms, efficient in-hospital work flow, and a multidisciplinary approach led to an outstanding outcome in this young patient.
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Affiliation(s)
- Rahul Rao
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Nameer Aladamat
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | | | - Mouhammad Jumaa
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Syed Zaidi
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
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9
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Malerba P, Laera N, Pagnesi M, Bonzi B, Rizzoni D, Metra M, Nardin M. Right ventricular thrombosis: from a case report to pathophysiology mechanisms and current treatment options. J Cardiovasc Med (Hagerstown) 2024; 25:88-94. [PMID: 38064342 DOI: 10.2459/jcm.0000000000001551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Paolo Malerba
- Division of Medicine, Department of Medicine, ASST Spedali Civili, Montichiari
- Department of Clinical and Experimental Sciences, University of Brescia
| | - Nicola Laera
- Department of Clinical and Experimental Sciences, University of Brescia
- Second Medicine Division, Department of Medicine, ASST Spedali Civili
| | | | - Bianca Bonzi
- Division of Medicine, Department of Medicine, ASST Spedali Civili, Montichiari
| | - Damiano Rizzoni
- Division of Medicine, Department of Medicine, ASST Spedali Civili, Montichiari
- Department of Clinical and Experimental Sciences, University of Brescia
| | - Marco Metra
- Division of Cardiology, ASST Spedali Civili
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Matteo Nardin
- Department of Biomedical Sciences, Humanitas University, Milan
- Third Medicine Division, Department of Medicine, ASST Spedali Civili, Brescia, Italy
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10
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Kandemir O, Boysan E, Circi R, Turker T, Cicekcioglu F. A Right Ventricular Mass With Intracavitary Obliteration: Tumor or Thrombus? Cureus 2023; 15:e50809. [PMID: 38249167 PMCID: PMC10796752 DOI: 10.7759/cureus.50809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 01/23/2024] Open
Abstract
A 47-year-old woman was admitted to the hospital because of dyspnea for the past three months. She was previously diagnosed with pulmonary embolism. She had been operated on for a colon tumor five years ago and no residual cancer was detected on oncological follow-up. Her transthoracic echocardiographic and transesophageal echocardiographic evaluation showed a hypertrophic right ventricle occupied by a 2.7 x 4.8 cm immobile mass obliterated to the right ventricle cavity. All the non-invasive tests were consistent with thrombus prediagnosis. She underwent surgery. Mass was resected from the right ventricle as much as possible. Histopathology of surgical material revealed metastatic spindle cell adenocarcinoma. We aim to increase the awareness of the differential diagnosis of thrombus or tumor, thereby leading to appropriate management.
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Affiliation(s)
- Ozer Kandemir
- Cardiovascular Surgery, Etlik Şehir Hastanesi, Ankara, TUR
| | - Emre Boysan
- Cardiovascular Surgery, Etlik Şehir Hastanesi, Ankara, TUR
| | - Renda Circi
- Cardiovascular Surgery, Etlik Şehir Hastanesi, Ankara, TUR
| | - Tugce Turker
- Cardiovascular Surgery, Etlik Şehir Hastanesi, Ankara, TUR
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11
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Ba-Shammakh SA, Al-Zughali EA, Al-Shami NA, Al-Darobi AH, Abuaisha HA, Karabsheh S. Managing Pulmonary Embolism With Right Ventricular Thrombus in In Vitro Fertilization-Related Pregnancy: A Clinical Insight. Cureus 2023; 15:e51383. [PMID: 38292994 PMCID: PMC10825887 DOI: 10.7759/cureus.51383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2023] [Indexed: 02/01/2024] Open
Abstract
This case study provides an insightful examination of the management of high-risk pulmonary embolism (PE) in a 27-year-old pregnant patient following in vitro fertilization (IVF). Overlapping symptoms of PE and typical pregnancy manifestations, coupled with concerns about radiation exposure from diagnostic imaging, presented unique diagnostic challenges. Despite the heightened risk of thrombosis during pregnancy and elevated D-dimer levels, a conservative approach was strategically employed. This involved therapeutic anticoagulation using low-molecular-weight heparin, leading to significant patient improvement without the need for invasive interventions. This case highlights the imperative for a judicious yet proactive approach in managing PE among pregnant patients, meticulously considering both maternal and fetal health risks.
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Affiliation(s)
| | | | | | - Ali H Al-Darobi
- Banner MD Anderson Cancer Center, Banner Gateway Medical Center, Arizona, USA
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12
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Carroll K, Goncalves J, Kalimi R, Manvar-Singh P. Hemodialysis catheter-related right atrial thrombus treated with the FlowTriever system. J Vasc Surg Cases Innov Tech 2023; 9:101318. [PMID: 38106355 PMCID: PMC10725059 DOI: 10.1016/j.jvscit.2023.101318] [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: 04/27/2023] [Accepted: 08/22/2023] [Indexed: 12/19/2023] Open
Abstract
Tunneled catheters are frequently used in patients with end-stage renal disease who require hemodialysis access. Catheter-related atrial thrombus is a documented complication of prolonged catheter use. The incidence of catheter-related atrial thrombus is 2% to 29%, with a high mortality rate approaching 20%, raising concerns for serious complications and death in the absence of an established universal management plan. This case series demonstrates the successful use of a minimally invasive approach to treat patients with intracardiac thrombus and high perioperative risk factors using mechanical and aspiration thrombectomy with the FlowTriever system (Inari Medical).
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Affiliation(s)
- Kevin Carroll
- Department of Surgery at South Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell Health, Bay Shore, NY
| | - John Goncalves
- Department of Cardiothoracic Surgery at South Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell Health, Bay Shore, NY
| | - Robert Kalimi
- Department of Cardiothoracic Surgery at South Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell Health, Bay Shore, NY
| | - Pallavi Manvar-Singh
- Department of Surgery at South Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell Health, Bay Shore, NY
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13
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Feldman JM, Frishman WH, Aronow WS. Review of the Etiology, Diagnosis, Classification, and Therapy of Right Heart Thrombi. Cardiol Rev 2023:00045415-990000000-00176. [PMID: 37966248 DOI: 10.1097/crd.0000000000000630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Right heart thrombi are a rare phenomenon associated with high mortality rates and embolization to the pulmonary bed. Diagnostic modalities include transthoracic echocardiography, contrast-enhanced echocardiography, and cardiac magnetic resonance imaging. Several treatment options for right ventricular thrombus have been described in case reports and observational studies including anticoagulation, thrombolysis, catheter-based procedures, and surgical embolectomy. Various studies have demonstrated that thrombolysis and surgical embolectomy have better survival outcomes than anticoagulation alone. Present management strategies are supported by observational studies, and further research is needed to guide therapy.
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Affiliation(s)
- Jared M Feldman
- From the Division of Hospital Medicine, Long Island Jewish Medical Center and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | - William H Frishman
- Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
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14
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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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15
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Alves Pinto R, Torres S, Formigo M, Sousa E, Coentrão L, Neves A, Macedo F, Maciel MJ, Oliveira T. Treatment of intracardiac thrombi using ultra-slow low-dose thrombolytic therapy: A case report. Rev Port Cardiol 2023; 42:925-928. [PMID: 37156417 DOI: 10.1016/j.repc.2019.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/18/2019] [Accepted: 09/29/2019] [Indexed: 05/10/2023] Open
Abstract
A 57-year-old male with previously known severe primary mitral regurgitation was admitted to the intensive care unit (ICU) due to massive venous thromboembolism, associated with right ventricular dysfunction and two large mobile right atrial thrombi. Due to deterioration in his clinical condition despite standard treatment with unfractionated heparin, it was decided to use an ultra-slow low-dose thrombolysis protocol, which consisted of a 24-hour infusion of 24 mg of alteplase at a rate of 1 mg per hour, without initial bolus. The treatment was continued for 48 consecutive hours, with clinical improvement and resolution of the intracardiac thrombi and no complications. One month after ICU admission, successful mitral valve repair surgery was conducted. This case demonstrates that ultra-slow low-dose thrombolysis is a valid bailout treatment option in patients with large intracardiac thrombi refractory to the standard approach.
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Affiliation(s)
- Ricardo Alves Pinto
- Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Porto, Portugal.
| | - Sofia Torres
- Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Mariana Formigo
- Serviço de Medicina Intensiva, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Elsa Sousa
- Serviço de Medicina Intensiva, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Luís Coentrão
- Serviço de Medicina Intensiva, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Aida Neves
- Serviço de Medicina Intensiva, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Filipe Macedo
- Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Maria Júlia Maciel
- Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Teresa Oliveira
- Serviço de Medicina Intensiva, Centro Hospitalar Universitário de São João, Porto, Portugal
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16
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Kim KW, Wheeler M, Schneider F, Carino G. Mechanical Thrombectomy for a Clot in Transit With Adherence to the Tricuspid Valve. Cureus 2023; 15:e46636. [PMID: 37936985 PMCID: PMC10627110 DOI: 10.7759/cureus.46636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 11/09/2023] Open
Abstract
This case report investigates the management of a clot in transit (CIT), a rare but possibly life-threatening condition discovered in a small percentage of pulmonary embolism (PE) cases. CITs are thrombi lodged within the right-side heart chambers or the major veins, and there are currently no universal guidelines for their management though the literature has shown reduced mortality with reperfusion therapy compared to anticoagulation alone. In this case, a 96-year-old male who presented with a submassive PE was initially stabilized with anticoagulation and was then discovered to have a CIT with adherence to the tricuspid valve. The patient underwent a successful mechanical thrombectomy using the Inari FlowTriever (Inari Medical, Irvine, CA), an FDA-approved device for CIT removal. Overall, this manuscript supports this percutaneous intervention in intermediate to high-risk PE patients with concomitant CIT, offering an alternative to thrombolysis and cardiothoracic surgery, which carry their own risks. Furthermore, the unique characteristic of the CIT in this patient suggests a potential for further investigation into the diversity of CIT morphology and its significance.
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Affiliation(s)
- Kang Woo Kim
- Internal Medicine, Brown University, Providence, USA
| | - Mareril Wheeler
- Pulmonary and Critical Care, Brown University, Providence, USA
| | | | - Gerardo Carino
- Pulmonary and Critical Care, Brown University, Providence, USA
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17
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Blasco-Turrión S, Plaza-Martín M, Amat-Santos IJ. Case Report: emergent percutaneous directional thrombectomy in a patient with cardiogenic shock and large mobile thrombus in the right atrium. Eur Heart J Case Rep 2023; 7:ytad428. [PMID: 37705942 PMCID: PMC10496867 DOI: 10.1093/ehjcr/ytad428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 08/14/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023]
Abstract
Background New percutaneous techniques for the management of acute pulmonary embolism (PE) are emerging, but there is lack of data regarding the approach of mobile thrombus in the right chambers, with the added risk of potential thrombus dislodgement that may prevent from mechanical circulatory support devices to be implanted in unstable patients. Case summary We present the case of a 65-year-old male with cardiogenic shock of unknown aetiology, severe biventricular dysfunction, and large mobile thrombus in the right atrium. Mechanical circulatory support devices could not be implanted, and current thromboaspiration systems were either too small or not available at that time. However, the patient's condition deteriorated rapidly with thrombus in transit, hence, a novel approach was required: using a deflectable 14 Fr sheath, directional thrombectomy was performed, achieving complete extraction of the thrombi and allowing for circulatory support with extracorporeal membrane oxygenation (ECMO) to be implanted with outstanding results and progressive weaning of all intensive care measures. Discussion Despite the growing interest in the development of percutaneous strategies for acute PE, there is no evidence-based guidelines regarding the treatment of mobile right heart thrombus. Even though some cases of percutaneous right heart thrombectomy have been reported, it is still a challenging scenario, given the potential risk of thrombus dislodgement and atrial perforation. We describe a novel technique of percutaneous directional thrombectomy in a patient with cardiogenic shock of unknown aetiology and large mobile thrombi in the right atrium as a bridge to ECMO proving to be a feasible alternative to treat thrombus in transit.
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Affiliation(s)
- Sara Blasco-Turrión
- Interventional Cardiology Unit, University Clinical Hospital of Valladolid, Avda Ramón y Cajal, 3, Valladolid 47003, Spain
| | - María Plaza-Martín
- Cardiovascular Intensive Care Unit, University Clinical Hospital of Valladolid, Avda Ramón y Cajal, 3, Valladolid 47003, Spain
| | - Ignacio J Amat-Santos
- Interventional Cardiology Unit, University Clinical Hospital of Valladolid, Avda Ramón y Cajal, 3, Valladolid 47003, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), C. de Melchor Fernández Almagro, 3, Spain
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18
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Nasser MF, Jabri A, Limaye S, Sharma S, Hamade H, Mhanna M, Aneja A, Gandhi S. Echocardiographic Evaluation of Pulmonary Embolism: A Review. J Am Soc Echocardiogr 2023; 36:906-912. [PMID: 37209948 DOI: 10.1016/j.echo.2023.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/22/2023]
Abstract
Pulmonary embolism (PE) is the third most common cause of cardiovascular death in the United States. Appropriate risk stratification is an important component of the initial evaluation for acute management of these patients. Echocardiography plays a crucial role in the risk stratification of patients with PE. In this literature review, we describe the current strategies in risk stratification of patients with PE using echocardiography and the role of echocardiography in the diagnosis of PE.
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Affiliation(s)
- Mohamed Farhan Nasser
- Heart and Vascular Center, Case Western Reserve University/Metrohealth Medical Center, Cleveland, Ohio
| | - Ahmad Jabri
- Heart and Vascular Center, Case Western Reserve University/Metrohealth Medical Center, Cleveland, Ohio
| | - Sneha Limaye
- Department of Medicine, Case Western Reserve University/Metrohealth Medical Center, Cleveland, Ohio
| | - Shorabh Sharma
- Department of Medicine, St. Barnabas Hospital Health System, New York, New York
| | - Hani Hamade
- Department of Medicine, Case Western Reserve University/Metrohealth Medical Center, Cleveland, Ohio
| | | | - Ashish Aneja
- Heart and Vascular Center, Case Western Reserve University/Metrohealth Medical Center, Cleveland, Ohio
| | - Sanjay Gandhi
- Heart and Vascular Center, Case Western Reserve University/Metrohealth Medical Center, Cleveland, Ohio.
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19
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Karunanandaa A, Patel N, Wong P, Vo C, Van Tienderen M, Huh W, Cantor E, Piester T, Cleveland J, Berman DP. Novel Use of the ŌNŌ Retrieval System for Intracardiac Thrombectomy in a High-Risk Pediatric Patient. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100976. [PMID: 39131649 PMCID: PMC11308530 DOI: 10.1016/j.jscai.2023.100976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/12/2023] [Accepted: 03/28/2023] [Indexed: 08/13/2024]
Affiliation(s)
| | - Neil Patel
- Children’s Hospital Los Angeles, Los Angeles, California
| | - Pierre Wong
- Children’s Hospital Los Angeles, Los Angeles, California
| | - Clementine Vo
- Children’s Hospital Los Angeles, Los Angeles, California
| | | | - Winston Huh
- Children’s Hospital Los Angeles, Los Angeles, California
| | - Emma Cantor
- Children’s Hospital Los Angeles, Los Angeles, California
| | - Travis Piester
- Children’s Hospital Los Angeles, Los Angeles, California
| | - John Cleveland
- Children’s Hospital Los Angeles, Los Angeles, California
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20
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Hussain RN, Mandal AKJ, Li N, Kafsi JE, Sioftanos A, Missouris CG. Right heart thrombus in transit and peripherally inserted central catheters. Thromb J 2023; 21:68. [PMID: 37349797 DOI: 10.1186/s12959-023-00513-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/11/2023] [Indexed: 06/24/2023] Open
Abstract
Right heart thrombus in transit or "free-floating right heart thrombus" is defined as thrombus(i) arising from the deep veins that embolises to the right atrium or right ventricle before reaching the pulmonary vasculature. It is almost always associated with pulmonary thromboembolism and is a medical emergency with reported mortality rates of over 40%. We present two cases of right heart thrombus in transit with pulmonary thromboembolism resulting from venous thrombosis associated with peripherally inserted central catheters that were managed with different approaches. The cases highlight that clinicians should have a low threshold to utilise imaging modalities such as computerised tomography and transthoracic echocardiography when there is an untoward change in physiological parameters among patients with peripherally inserted central catheters, particularly those with risk factors for peripherally inserted central catheter associated venous thrombosis. Furthermore, procedural optimisation surrounding peripherally inserted central catheters, such as insertion technique and choice of lumen size, is underscored.
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Affiliation(s)
- Rezwan N Hussain
- Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK
| | - Amit K J Mandal
- Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK.
| | - Nick Li
- Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK
- The Queen's College, University of Oxford, Oxford, UK
| | - Jihène El Kafsi
- Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK
- Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
| | | | - Constantinos G Missouris
- Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK
- University of Nicosia Medical School, Nicosia, Cyprus
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21
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Haque MZ, Akbar T, Saleem A, Husain M. Becker muscular dystrophy and successful intervention with mechanical thrombectomy of right atrial clot-in-transit with pulmonary embolism. Clin Case Rep 2023; 11:e7390. [PMID: 37229396 PMCID: PMC10202822 DOI: 10.1002/ccr3.7390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/28/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
This case report discusses the effectiveness of the Inari FlowTriever system in treating a right atrial (RA) clot in-transit in a 55-year-old male patient with Becker's muscular dystrophy (BMD). BMD is an X-linked recessive muscle disease caused by mutations in the gene that code for the protein dystrophin, which is associated with partially functional dystrophin in variable amounts. Right heart thrombi (RHT) are thrombi that can be visualized in the right atrium, right ventricle, or proximal surrounding vasculature. The Inari FlowTriever system was used to treat RA clot in-transit and removed acute, subacute, and chronic clot in a single session without the use of thrombolytics and subsequent ICU stay. The estimated blood loss with the FlowSaver system was approximately 150 mL. This report complements the FLARE study by highlighting the effectiveness of the FlowTriever system for mechanical thrombectomy of RA clot-in-transit in a patient with BMD.
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Affiliation(s)
- Mahfujul Z. Haque
- Michigan State University College of Human MedicineGrand RapidsMichiganUSA
| | - Taha Akbar
- The Ohio State University College of Arts and SciencesColumbusOhioUSA
| | - Abdulmalik Saleem
- Department of Internal MedicineHenry Ford HospitalDetroitMichiganUSA
| | - Mashkur Husain
- Downriver Heart & Vascular Specialists PCSouthgateMichiganUSA
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22
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Önder R, Taçkin VB, Kemaloğlu C, Gölbaşi İ. Thrombolytic treatment of right atrial thrombus in a patient with B cell acute lymphoblastic leukemia: a case report. Indian J Thorac Cardiovasc Surg 2023; 39:170-173. [PMID: 36785606 PMCID: PMC9918679 DOI: 10.1007/s12055-022-01424-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/26/2022] Open
Abstract
Right atrial thrombus is a severe complication of central venous catheterization (CVC). Concomitant pulmonary embolism may aggravate the clinical picture by causing or increasing shortness of breath and decreasing effort capacity, palpitations, and tricuspid valve regurgitation. A 32-year-old female patient with B cell acute lymphoblastic leukemia receiving chemotherapy was treated with alteplase thrombolysis because of the development of catheter-related right atrial thrombus and accompanying pulmonary embolism. On echocardiography, it was observed that the thrombus in the right atrium had regressed completely, but thrombus was seen in the right main pulmonary artery. The same dose of alteplase was given 2 days later. There was no significant change in the echocardiography. Therefore, ultrasound-assisted catheter-directed thrombolysis was applied. Clinical and radiological improvement was observed.
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Affiliation(s)
- Rauf Önder
- Department of Cardiovascular Surgery, Akdeniz University Hospital, H Block Floor:1, Konyaalti, Antalya, 07070 Antalya, Turkey
| | - Veli Burak Taçkin
- Department of Cardiovascular Surgery, Akdeniz University Hospital, H Block Floor:1, Konyaalti, Antalya, 07070 Antalya, Turkey
| | - Cemal Kemaloğlu
- Department of Cardiovascular Surgery, Akdeniz University Hospital, H Block Floor:1, Konyaalti, Antalya, 07070 Antalya, Turkey
| | - İlhan Gölbaşi
- Department of Cardiovascular Surgery, Akdeniz University Hospital, H Block Floor:1, Konyaalti, Antalya, 07070 Antalya, Turkey
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23
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Igwilo R, Pinsino A, Aksan F, Kapoor S. Clot-in-transit: A ticking time bomb in the heart with serious consequences. SAGE Open Med Case Rep 2023; 11:2050313X231151504. [PMID: 36776203 PMCID: PMC9909048 DOI: 10.1177/2050313x231151504] [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: 10/11/2022] [Accepted: 12/27/2022] [Indexed: 02/10/2023] Open
Abstract
Clot-in-transit is associated with severe pulmonary embolism and higher mortality than acute pulmonary embolism without clot-in-transit. The optimal treatment of clot-in-transit is not established. Multiple treatment options have been described, including anticoagulation alone, systemic thrombolysis, surgical embolectomy and endovascular catheter-based therapies. Clot-in-transit can embolize to the pulmonary circulation in a matter of seconds and be immediately fatal. We describe two cases of clot-in-transit which embolized quickly upon Intensivist's evaluation and were associated with serious consequences. Management decisions for clot-in-transit should be emergent and based on multidisciplinary discussion of the pulmonary embolism response team.
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Affiliation(s)
- Rita Igwilo
- Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alberto Pinsino
- Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Feyzullah Aksan
- Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sumit Kapoor
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA,Sumit Kapoor, Department of Critical Care Medicine, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
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24
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Li LT, Alexis M, Wilson SR, Yu PJ. Suction-based catheter retrieval of right ventricular clot-in-transit. Catheter Cardiovasc Interv 2023; 101:478-480. [PMID: 36573416 DOI: 10.1002/ccd.30533] [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] [Received: 10/29/2022] [Revised: 12/06/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022]
Abstract
Right ventricular clot-in-transit (CIT) is a rare finding in venous thromboembolic disease and carries a high mortality rate. Its optimal treatments have yet to be established in the literature. Here we describe the usage of a suction-based catheter, the INARI FlowTriever® system (INARI Medical Inc.) to successfully retrieve a CIT from the right ventricle of a patient with coronavirus disease 2019 acute respiratory distress syndrome on veno-veno extracorporeal membrane oxygenation.
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Affiliation(s)
- Leo T Li
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, New York, USA
| | - Miguel Alexis
- Division of Cardiovascular and Thoracic Surgery, Northwell Health, North Shore University Hospital, New York, Manhasset, USA
| | - Sean R Wilson
- Department of Cardiology, North Shore University Hospital, Manhasset, New York, USA
| | - Pey-Jen Yu
- Division of Cardiovascular and Thoracic Surgery, Northwell Health, North Shore University Hospital, New York, Manhasset, USA
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25
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Mahjani M, Gohari S, Ahangar H. Low dose ultra-slow infusion thrombolytic therapy (LDUSITT) as an alternative option in a COVID-19 patient with free-floating right atrial thrombus: a case report and review of literature. Thromb J 2023; 21:12. [PMID: 36710332 PMCID: PMC9884518 DOI: 10.1186/s12959-023-00457-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
The hyper-coagulopathy nature of COVID-19 is a prevalent consequence among patients. Free-floating right atrial thrombi are a relatively rare finding and the optimal therapy is a therapeutic dilemma.We present a 37-year-old woman with acute dyspnea and fatigue. Several ground glass opacities were shown on computed tomography of chest that further proved to be associated with severe COVID-19 disease. A transthoracic echocardiography revealed a mobile right atrial mass with bilateral pulmonary embolism. She was considered high risk for surgical therapy by cardiovascular surgeons. She was then started on anticoagulation therapy for 5 days however the size regression of the thrombus remained unchanged. A regimen of low dose (24 mg) ultra-slow (24 h) intravenous infusion of alteplase, without bolus was initiated. Following the third day of thrombolytic therapy, the control echocardiography demonstrated complete resolution of the thrombus.Prolonged infusion of low dose fibrinolytics can be an alternative treatment to surgery for right heart thrombi.
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Affiliation(s)
- Mahsa Mahjani
- Endocrine Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Family Medicine, Alborz University of Medical Science, Alborz, Iran
| | - Sepehr Gohari
- Department of Family Medicine, Alborz University of Medical Science, Alborz, Iran
- Student Research Center, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Hassan Ahangar
- Department of Cardiology, Mousavi Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
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26
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Patail H, Cheema M, McKay R, Ingrassia J. Characteristics and outcomes of angiovac-assisted debulking of intracardiac masses, thrombi, and endocarditis. Clin Res Cardiol 2022; 112:626-632. [PMID: 36583764 DOI: 10.1007/s00392-022-02146-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Traditional management for right-sided infective endocarditis and other adherent masses centers around balancing the risks and benefits of open surgical removal against medical therapy. METHODS Single-center study analysis of 19 patients who underwent vacuum-assisted debulking and/or en bloc removal of right-sided infective endocarditis and other adherent masses between September 2017 and November 2021. Clinical outcomes during the perioperative period, postoperative period, hospital course, and post-discharge were analyzed. RESULTS We included 12 male and 7 female patients with an average age 47.4 ± 16.8. Relevant risk factors included 47.4% of patients with active intravenous drug use (IVDU), 21.1% of patients with a history of permanent pacemaker (PPM) or implantable cardioverter-defibrillator (ICD), and 5.3% of prior malignancy with mediastinal radiation. 31.6% of patients had documented right-sided masses from a non-infectious etiology, while 68.4% of patients were noted to have right-sided infective endocarditis (RSIE). All patients were found to have large, mobile masses or vegetations at high risk for embolization to the pulmonary vasculature. Average in-hospital length of stay was 17.8 ± 12.2 days, blood cultures cleared postoperatively in 8.9 ± 7.3 days, periprocedural mortality was 0%, subsequent open surgical valvular repair during the same admission was 5.3%, and in-hospital mortality was 5.3%. Within 6 weeks of follow-up, 15.8% of patients were readmitted for recurrence of bacteremia, 10.5% of patients were found to have new pulmonary embolism, and 15.8% of patients underwent open surgical valvular repair. Total death after 1-year and 2-years was 15.8% and 5.3%, respectively. Recurrence of bacteremia was 21.1% within 1-year. CONCLUSION AngioVac is a viable therapeutic strategy for select patients with intravascular and intracardiac right-sided masses including thrombi, emboli, or infective masses such as endocarditis.
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Affiliation(s)
- Haris Patail
- Department Internal Medicine, University of Connecticut, Farmington, USA.
| | | | - Raymond McKay
- Department of Cardiology, Hartford Hospital, Hartford, USA
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27
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Bajwa A, Farooqui SM, Hussain ST, Vandyck K. Right heart thrombus in transit: Raising bar in the management of cardiac arrest. Respir Med Case Rep 2022; 41:101801. [PMID: 36618850 PMCID: PMC9817167 DOI: 10.1016/j.rmcr.2022.101801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/07/2022] [Accepted: 12/18/2022] [Indexed: 12/31/2022] Open
Abstract
Right heart thrombus represents medical emergency as it is associated with acute pulmonary embolism. Right heart thrombus can manifest acutely in a dramatic fashion as cardiac arrest. Bedside echocardiography is a key to rapid diagnosis and allow early intervention. We report a case of elderly female who was admitted to our hospital after a mechanical fall and found to have hip fracture. Despite an initial uncomplicated course, she experienced cardiopulmonary arrest with right heart clot in transit identified on transesophageal echocardiography (TEE). We highlight the utility of point-of-care ultrasound as well as use of TEE to establish cause of cardiopulmonary arrest.
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Affiliation(s)
- Awais Bajwa
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Corresponding author. Department of Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd. AAT 6300, Oklahoma City, OK, 73104, USA.
| | - Samid M. Farooqui
- Section of Pulmonary, Critical Care, and Sleep Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Syed T. Hussain
- Section of Pulmonary, Critical Care, and Sleep Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Kofi Vandyck
- Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
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28
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Rahim S, Rampoldi M, Sills M, Carry MM. Lost and Found: Identifying Right Pulmonary Embolus in Transit Using the Suprasternal Notch Approach. CASE (PHILADELPHIA, PA.) 2022; 6:400-405. [PMID: 36451870 PMCID: PMC9703094 DOI: 10.1016/j.case.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
• The SSN window is critical in detecting clot in transit leading to saddle thrombus. • The RPA may be the only place that PE can be visualized. • SSN views provide accurate data necessary to confirm thrombus in pulmonary arteries.
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Affiliation(s)
- Sajjadur Rahim
- Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas
| | - Michael Rampoldi
- Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas
| | - Michael Sills
- Baylor Scott and White Cardiology Consultants of Texas, Dallas, Texas
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29
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A Rare Case of Tricuspid Valve Libman–Sacks Endocarditis in a Pregnant Woman with Primary Antiphospholipid Syndrome. J Clin Med 2022; 11:jcm11195875. [PMID: 36233742 PMCID: PMC9573308 DOI: 10.3390/jcm11195875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 11/17/2022] Open
Abstract
Antiphospholipid Antibody Syndrome (APS) is a systemic autoimmune disease characterized by acquired hypercoagulability with the possible development of venous, arterial, and microvascular thrombosis. We report a rare case of Libman–Sacks tricuspid valve endocarditis in a 38-year-old pregnant woman at 15 weeks gestation with unknown primary antiphospholipid syndrome. During a routine cardiac examination and echocardiography performed for a previous episode of pleuropericarditis, a large, mobile mass with irregular edges was found at the level of the tricuspid valve. Three main differential diagnoses for intramyocardial mass were examined: tumor, infective endocarditis, and nonbacterial thrombotic endocarditis (NTBE). Cardiac magnetic resonance imaging (CMR) with contrast raised the suspicion of a thrombus. The woman was hospitalized urgently at the Cardiac Intensive Care Unit of the Federico II University Hospital, and anticoagulant and antiplatelet therapy were started. The thrombophilic screening performed and medical history confirmed the diagnosis of primary antibody syndrome (APS). A multidisciplinary consultation with obstetricians, cardiologists, anesthetists, and cardiac surgeons was required. The patient decided not to terminate the pregnancy despite the risk to her health and to undergo cardiac surgery during pregnancy. Histological examination confirmed the presence of nonbacterial thrombotic endocarditis. Weekly obstetric scans were performed after surgery to verify fetal well-being. An emergency cesarean section was performed at the 35th week of gestation due to repeated deceleration and abnormal short-term variability on c-CTG in a pregnancy complicated by fetal growth restriction and gestational hypertension. A newborn weighing 1290 g was born. She was hospitalized in Neonatal Intensive Care and discharged after two months; currently, she enjoys good health. The management of patients with antiphospholipid antibody syndrome has not yet been standardized, but there is a general consensus that patients who do not have thrombocytopenia, thromboembolic phenomena, or pregnancy should not undergo any treatment or should take only low doses of acetylsalicylic acid. In the presence of any of the above conditions, various treatment regimens have been used based on the severity and individuality of the case.
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Medina-Mur R, Vasquez-Rodríguez JF, Giraldo-Peniche LE, Idrovo-Turbay C, Gelves-Meza J, Jaimes C. Diagnostic challenge presented by right atrial mass: A report of two cases. Radiol Case Rep 2022; 17:3886-3892. [PMID: 35991379 PMCID: PMC9389139 DOI: 10.1016/j.radcr.2022.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 11/28/2022] Open
Abstract
Right atrial masses raised pose 3 major possibilities including tumors, thrombi, or vegetations. We present 2 cases: first, a 34-year-old male with no medical history, who presented with dyspnea, pleuritic pain, and fever; and the second, 65-year-old male with similar symptoms and a history of a left renal carcinoma. Both patients had right atrial masses found on a transthoracic echocardiogram. Cardiac magnetic resonance imaging and an 18 FDG-PET were necessary finding thrombi in the first patient; and tumoral thrombi in the second one. A multimodality imaging approach to right atrial masses is essential for proper diagnosis and therapeutic decision-making.
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Mathevosian S, Ranade M. Right Heart Clot-in-Transit: Endovascular Therapies. Semin Intervent Radiol 2022; 39:515-522. [PMID: 36561934 PMCID: PMC9767789 DOI: 10.1055/s-0042-1757942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Right heart thrombus is a challenging high mortality disease typically seen in the setting of pulmonary embolism. Traditional treatments have included anticoagulation, thrombolysis, and surgical embolectomy. Advances in recognition and treatment of clot-in-transit have led to the development of endovascular therapies increasingly becoming the preferred method of treatment due to rapid debulking and lower morbidity. Novel endovascular devices are large bore aspiration thrombectomy systems which mitigate the use of concomitant thrombolytics. The article reviews the disease process, relevant literature, and current endovascular devices and strategies for the treatment of right heart thrombus and clot-in-transit.
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Affiliation(s)
- Sipan Mathevosian
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Mona Ranade
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California
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Alam K, Pendlebury GA, Oro P, McAlister J, Hashmi T, Ijaz HM, Chaudhry A, Ergle K. Application of Aspiration-Assisted Percutaneous Venous Removal of Right Atrial Thrombus in a Critically Ill Patient: A Case Study and Clinical Management Overview. Cureus 2022; 14:e28852. [PMID: 36159347 PMCID: PMC9491628 DOI: 10.7759/cureus.28852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/06/2022] [Indexed: 11/10/2022] Open
Abstract
We herein present a complex case of a 50-year-old female with catheter-related atrial thrombus (CRAT). This patient with end-stage renal disease on hemodialysis presented with angioedema leading to respiratory failure. She was subsequently intubated, and the pre-procedural course was complicated by a cardio-respiratory arrest, and anoxic brain injury. The patient’s hemodialysis catheter placement in the superior vena cava (SVC) potentially correlated with the development of the right atrial thrombus. The patient was treated percutaneously as she presented with complex morbidities. The mass was successfully removed via aspiration-assisted percutaneous right heart bypass, a procedure that utilizes a vacuum system to remove thrombi. Post-procedure, the patient remained stable and continued supervised care.
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Patel AN, Amrutiya RJ, Manvar BN. A Proposed Approach for the Management of Clot-in-Transit. Cureus 2022; 14:e28481. [PMID: 36176887 PMCID: PMC9512516 DOI: 10.7759/cureus.28481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 12/02/2022] Open
Abstract
Clot-in-transit (CIT) is defined as a mobile echogenic material in the right atrium or ventricle as observed on ultrasound. A right heart free-floating thrombus is unusual when there is no structural disease of the heart or atrial fibrillation. Cardiopulmonary collapse and quick death can come from CIT, which occurs when a blood clot moves from the heart to the lungs. There are some clinical case reports of a large volume thrombus that was freely floating in the right heart in an asymptomatic patient, and the best therapeutic options are uncertain. Although several trials have been conducted on the treatment of CIT, clinical judgment is still used to determine the best treatment for right heart thrombus (RHT), especially when associated with pulmonary embolism (PE). In this review article, we discuss various diagnostic modalities and treatment options for this rare malady. We studied in detail their clinical impact on patients according to past research studies.
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Goh FQ, Leow AS, Ho JS, Ho AF, Tan BY, Yeo LL, Li TY, Galupo MJ, Chan MY, Yeo TC, Wong RC, Chai P, Sia CH. Clinical Characteristics, Treatment and Long-Term Outcomes of Patients with Right-Sided Cardiac Thrombus. Hellenic J Cardiol 2022; 68:1-8. [PMID: 35987512 DOI: 10.1016/j.hjc.2022.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 07/31/2022] [Accepted: 07/31/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Right-sided cardiac thrombus is rare and may be caused by venous thromboembolism, in association with medical devices or stasis of blood in atrial fibrillation and cardiomyopathies. Complications include pulmonary embolism (PE) and paradoxical stroke. Current data are limited and mostly from case series and PE registries. We aimed to describe the clinical characteristics, echocardiographic features, treatment and outcomes of right-sided cardiac thrombus patients. METHODS This was a retrospective observational study of 97 consecutive patients with right-sided cardiac thrombus detected on echocardiography. We studied co-morbidities, predisposing factors, thrombus characteristics and therapeutic interventions and assessed their associations with development of PE, paradoxical stroke, circulatory collapse and all-cause mortality. RESULTS Mean age was 58.7 years and 55/97 (56.7%) were female. Ischaemic heart disease, heart failure, chronic kidney disease and malignancy were common co-morbidities. Right atrial thrombus was often associated with medical devices while right ventricular thrombus was more commonly associated with cardiomyopathy. Thrombus mobility did not affect embolic events but was associated with greater short-term mortality. On multivariable analysis, anticoagulation (HR 0.25, 95% CI 0.09-0.68) and thrombus resolution (HR 0.28, 95% CI 0.13-0.62) were associated with greater survival. CONCLUSIONS Right-sided cardiac thrombus is rare but may have potentially life-threatening complications such as PE and paradoxical stroke. Further research is needed to determine optimal therapeutic strategies in this poorly-studied population.
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Affiliation(s)
- Fang Qin Goh
- National University Hospital, National University Health System, Singapore
| | - Aloysius St Leow
- National University Hospital, National University Health System, Singapore
| | - Jamie Sy Ho
- Academic Foundation Program, Royal Free London NHS Foundation Trust, United Kingdom
| | - Andrew F Ho
- SingHealth Duke-NUS Emergency Medicine Academic Clinical Program, Singapore; National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore; Pre-hospital and Emergency Care Research Centre, Health Services and Systems Research, Duke-NUS Medical School
| | - Benjamin Yq Tan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Leonard Ll Yeo
- Division of Neurology, Department of Medicine, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tony Yw Li
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Mary Joyce Galupo
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Mark Y Chan
- Department of Cardiology, National University Heart Centre Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Raymond Cc Wong
- Department of Cardiology, National University Heart Centre Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ping Chai
- Department of Cardiology, National University Heart Centre Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Lane CM, Young KA, Norton MS, Bennett CE, Anavekar NS. Right Heart Thrombus in Transit on Point-of-Care Ultrasound: A Rare Finding with Key Management Repercussions. CASE 2022; 6:239-242. [PMID: 36036053 PMCID: PMC9399530 DOI: 10.1016/j.case.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Right heart thrombi are associated with high early mortality in PE. POCUS allows rapid assessment in hemodynamic compromise and suspected PE. Triple POCUS assessment of the lung, heart, and leg veins may improve PE detection.
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Affiliation(s)
- Conor M. Lane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kathleen A. Young
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mark S. Norton
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Nandan S. Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- Correspondence: Nandan S. Anavekar, MB, BCh, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
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Trott T, Bowman J. Diagnosis and Management of Pulmonary Embolism. Emerg Med Clin North Am 2022; 40:565-581. [DOI: 10.1016/j.emc.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shanmugasundaram M, Chatterjee A, Lee K. Percutaneous Large Thrombus and Vegetation Evacuation in the Catheterization Laboratory. Interv Cardiol Clin 2022; 11:349-358. [PMID: 35710288 DOI: 10.1016/j.iccl.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Intracardiac and intravascular thrombi are associated with significant morbidity and mortality. Although surgery remains the gold standard treatment option, these patients often have multiple comorbidities that can make surgical options challenging. With advancements in catheter-based technologies, there are now percutaneous treatment options for these patients. The AngioVac is a percutaneous vacuum-assisted thrombectomy device FDA-approved for removal of intravascular debris that uses a venovenous extracorporeal membranous oxygenation circuit with a filter. Use of this device has now been reported in the removal of right atrial or iliocaval thrombi, debulking tricuspid vegetations, removal of vegetations from implantable cardiac devices, and pulmonary embolism.
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Affiliation(s)
- Madhan Shanmugasundaram
- Section of Cardiology, Department of Internal Medicine, Banner University Medical Center, Sarver Heart Center, 1501 North Campbell Avenue, Tucson, AZ 85724, USA.
| | - Arka Chatterjee
- Section of Cardiology, Department of Internal Medicine, Banner University Medical Center, Sarver Heart Center, 1501 North Campbell Avenue, Tucson, AZ 85724, USA
| | - Kwan Lee
- Section of Cardiology, Department of Internal Medicine, Banner University Medical Center, Sarver Heart Center, 1501 North Campbell Avenue, Tucson, AZ 85724, USA
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Achuthanandan S, Harris CL, Farooqui AA, Hollander G. Right Ventricular Thrombus Masquerading as a Tumor. Cureus 2022; 14:e26014. [PMID: 35720779 PMCID: PMC9203128 DOI: 10.7759/cureus.26014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 12/02/2022] Open
Abstract
Cardiac tumors are an uncommon phenomenon. Although they can be cardiac in origin, most represent a distant neoplastic growth metastasizing to the heart. Cardiac tumors can be benign or malignant. They may be symptomatic or, more commonly, found incidentally. Clinical presentation is typically related to that of dispersed neoplasm. We report a case of a 36-year-old young man with an unusually large and smooth-surfaced right ventricular mass. The patient presented to the emergency department with exertional dyspnea for two weeks. Past medical history was significant for deep venous thrombosis with non-adherence to anti-coagulation. Computerized tomographic (CT) angiography showed bilateral pulmonary emboli and a hypodense opacity in the right ventricle. A transthoracic echocardiogram showed a right ventricular non-mobile mass. The patient underwent surgical removal of the mass, which pathology demonstrated to be a thrombus. Cardiac masses can be difficult to differentiate based on imaging alone. Physicians should maintain a high index of suspicion for intracardiac thrombi as early identification and prompt treatment are imperative in improving patient outcomes.
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Cheema T, Kieu T, Balek M, Ahmad M, Singh P. Pulmonary Embolism (PE) in Transit in Heparin-Induced Thrombocytopenia (HIT) With Negative Serotonin-Release Assay (SRA). Cureus 2022; 14:e25868. [PMID: 35698467 PMCID: PMC9188760 DOI: 10.7759/cureus.25868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2022] [Indexed: 11/12/2022] Open
Abstract
Pulmonary embolism (PE) is a potentially lethal condition, although frequently diagnosed, and is rarely associated with transit on initial presentation. Heparin-induced thrombocytopenia (HIT) can cause both arterial thrombus formation and venous thromboembolism. The two forms of HIT must be differentiated in order to guide management. We present a complex and unique case of PE in transit secondary to HIT diagnosed in a patient with a negative serotonin assay.
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40
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Martinho M, Calé R, Ferreira F, Pereira H. Large free-floating right atrial mass presenting as intermediate-high risk pulmonary embolism: is reperfusion a better definite strategy? BMJ Case Rep 2022; 15:e249225. [PMID: 35545309 PMCID: PMC9096487 DOI: 10.1136/bcr-2022-249225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 11/03/2022] Open
Abstract
We present a woman in her 60s diagnosed with an intermediate-high risk acute pulmonary embolism and a large, non-serpiginous right atrial (RA) mass. Conservative therapy with unfractionated heparin was started and further assessment of the mass with cardiac MRI suggested thrombus as the most likely diagnosis. Despite 1 month of anticoagulation, mass size remained stable and surgical RA embolectomy and left pulmonary endarterectomy was performed. Histopathology confirmed thrombus. The patient died 10 weeks after surgery.
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Affiliation(s)
- Mariana Martinho
- Cardiology Department, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Rita Calé
- Cardiology Department, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Filipa Ferreira
- Cardiology Department, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Helder Pereira
- Cardiology Department, Hospital Garcia de Orta EPE, Almada, Portugal
- Cardiovascular Center of the University of Lisbon, Lisbon, Portugal
- Academic Medical Center of Lisbon, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Farah Yusuf Mohamud M, Mukhtar MS, Hassan MO. Successfully thrombolysis using tenecteplase in a case of massive pulmonary embolism with multiple free-floating thromboses in the right atrium and right ventricle. Ann Med Surg (Lond) 2022; 77:103629. [PMID: 35638082 PMCID: PMC9142651 DOI: 10.1016/j.amsu.2022.103629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 12/01/2022] Open
Abstract
Massive pulmonary embolism (PE) combined with right atrial (RA) thrombus is associated with significant mortality. Hemodynamic collapses, which can manifest as hypotension, severe dyspnea; cyanosis, syncope, shock, and right ventricular heart failure are the hallmark of massive PE. Moreover, hemodynamic collapse can be the earliest clinical presentation and the most common cause of death in the first days. Although fibrinolytic therapy has contraindications; exclusion is necessary to minimize bleeding risk, but it can be lifesaving and prevent complications such as shock, right ventricular heart failure, and multi-system organ failure. Here, we report a 70-year-old woman who has an atypical presentation of sudden onset of a persistent hiccup for 8 hours diagnosed with massive pulmonary embolism with multiple free floating thromboses in the right atrial and right ventricle which has been successfully treated with systemic fibrinolytic. Furthermore, the patient was given a Tenecteplase as a last resort to save her life due to the unavailability of the catheter or surgical embolectomy besides an absolute contraindication for thrombolytic. Massive pulmonary embolism and associated with multiple free floating thromboses in the right atrium and right ventricle successfully treated with systemic fibrinolysis as the latest option to save a life in the presence of absolute contraindication, and this risk has exposed due to lack of availability of catheter or surgical embolectomy in our country. According to hemodynamic compromise of the patient resulting from the massive pulmonary embolism, the definitive treatment was pulmonary embolectomy. Due to the lack of availability for catheter or surgical embolectomy and other thrombolytic regimens, she became a candidate for emergent Tenecteplase administration as a last resort to save a life.
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Affiliation(s)
- Mohamed Farah Yusuf Mohamud
- Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
- Hage Institute of Medical Research, Mogadishu, Somalia
- Corresponding author. Mogadishu Somali-Turkish Training and Research Hospital, 30 Street, Alikamin, Wartanabada district, Mogadishu, Somalia.
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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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Sharma A, Machanahalli Balakrishna A, Sharma A, Slattery T. Right atrial appendage thrombus in a patient with a left atrial appendage occlusion device. Proc AMIA Symp 2022; 35:520-521. [DOI: 10.1080/08998280.2022.2065104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Arindam Sharma
- Department of Cardiology, Creighton University School of Medicine, Omaha, Nebraska
| | | | - Arunima Sharma
- Department of Endocrinology, Mayo Clinic, Rochester, Minnesota
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Khosla A, Mojibian H, Assi R, Tantawy H, Singh I, Pollak J. Right heart thrombi (RHT) and clot in transit with concomitant PE management: Approach and considerations. Pulm Circ 2022; 12:e12080. [PMID: 35514771 PMCID: PMC9063956 DOI: 10.1002/pul2.12080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/04/2022] [Accepted: 04/06/2022] [Indexed: 11/06/2022] Open
Abstract
Right heart thrombi (RHT) continues to pose a clinical dilemma for multiple specialties and is especially concerning when present with concomitant pulmonary embolism (PE). Patients with PE and RHT are at an increased risk of poor outcomes compared to PE without RHT. Although the exact incidence of RHT is unknown, the increasing use of point-of-care ultrasound may lead to an increased detection and frequency of RHT. There are multiple treatment strategies available for RHT, including anticoagulation, systemic thrombolysis, and endovascular and surgical therapies. Given that these treatment strategies involve multiple medical specialties, the management of RHT with concomitant PE can be complex. Currently, there is limited clinical data and guidelines on the treatment and management of RHT. We aim to provide a review on RHT with concomitant PE, including risk stratification, treatment considerations, and our approach to the management of RHT.
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Affiliation(s)
- Akhil Khosla
- Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of MedicineYale New Haven HospitalNew‐HavenConnecticutUSA
| | - Hamid Mojibian
- Department of Radiology and Biomedical Imaging, Section of Vascular and Interventional RadiologyYale University School of MedicineNew HavenConnecticutUSA
| | - Roland Assi
- Division of Cardiac SurgeryYale University School of MedicineNew HavenConnecticutUSA
| | - Hossam Tantawy
- Department of AnesthesiologyYale University School of MedicineNew HavenConnecticutUSA
| | - Inderjit Singh
- Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of MedicineYale New Haven HospitalNew‐HavenConnecticutUSA
| | - Jeffrey Pollak
- Department of Radiology and Biomedical Imaging, Section of Vascular and Interventional RadiologyYale University School of MedicineNew HavenConnecticutUSA
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Moriarty JM, Liao M, Kim GHJ, Yang E, Desai K, Ranade M, Plotnik AN. Procedural outcomes associated with use of the AngioVac System for right heart thrombi: A safety report from RAPID registry data. Vasc Med 2022; 27:277-282. [PMID: 35176918 DOI: 10.1177/1358863x211073974] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Right heart thrombi can be a source of considerable morbidity and mortality, especially when associated with pulmonary embolism. Methods: To understand the safety and procedural efficacy associated with vacuum-assisted thrombectomy using the AngioVac System (AngioDynamics, Latham, NY, USA) to remove right heart thrombi, we conducted a subanalysis of the Registry of AngioVac Procedures in Detail (RAPID) multicenter registry representing 47 (20.1%) of 234 participants in the registry. Forty-two (89.4%) patients had thrombi located in the right atrium alone, three (6.4%) in the right ventricle alone, and two (4.3%) in both the right atrium and ventricle. Four (8.5%) patients had concomitant caval thrombi, three (6.4%) also had catheter-related thrombi, and one (2.1%) patient had both caval and catheter-related thrombi with their right heart thrombi. Results: Extracorporeal bypass time was less than 1 hour for 39 (83.0%) procedures. Seventy to 100% removal of thrombus was achieved in 59.6% of patients. Estimated blood loss was less than 250 cc for 43 procedures (91.6%). Mean hemoglobin decreased from 10.7 ± 2.2 g/dL preoperatively to 9.6 ± 1.6 g/dL postoperatively. Transfusions were administered for eight procedures (17.0%), with only one (2.1%) patient receiving more than 2 units of blood. Six patients (12.8%) experienced procedure-related adverse events, including three (6.4%) patients who experienced distal emboli and three (6.4%) patients who developed bleeding-related complications. All adverse events resolved prior to discharge. There was one death (2.1%) reported that was not procedure related. Conclusion: Vacuum-assisted thrombectomy can be performed safely in patients with right heart thrombi. ClinicalTrials.gov Identifier: NCT04414332.
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Affiliation(s)
- John M Moriarty
- Department of Radiology, Division of Interventional Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Millie Liao
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Grace Hyun J Kim
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Medicine, Division of Cardiology, UCLA Medical Center, Los Angeles, CA, USA
| | - Eric Yang
- Department of Medicine, Division of Cardiology, UCLA Medical Center, Los Angeles, CA, USA
| | - Kush Desai
- Department of Radiology, Division of Interventional Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mona Ranade
- Department of Radiology, Division of Interventional Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Adam N Plotnik
- Department of Radiology, Division of Interventional Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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46
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Enezate T, Alkhatib D, Raja J, Chinta V, Patel M, Omran J. AngioVac for Minimally Invasive Removal of Intravascular and Intracardiac Masses: a Systematic Review. Curr Cardiol Rep 2022; 24:377-382. [PMID: 35129741 DOI: 10.1007/s11886-022-01658-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Management of intracardiac masses, such as right heart thrombi and catheter-related vegetations, can be challenging. Many patients are high-risk candidates for surgical extraction due to multiple comorbidities and risk of distal embolization. In this review, we highlight the advancements in percutaneous approaches for treatment of intracardiac masses utilizing AngioVac (AngioDynamic, Latham, NY). RECENT FINDINGS With the Food and Drug Administration (FDA) approval of the AngioVac System in 2009, a growing body of evidence has proven it to be a feasible and effective tool to extract thrombi and masses from the iliocaval system and the right heart. In this review, we highlight the feasibility of AngioVac System (AngioDynamic, Latham, NY) based on the published cases series and registries. Future randomized controlled trials are needed to establish an algorithmic approach in treating intracardiac masses.
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Affiliation(s)
- Tariq Enezate
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA.,Division of Cardiovascular Diseases, Memphis Veterans Affairs Medical Center, Memphis, TN, USA
| | - Deya Alkhatib
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Joel Raja
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Viswanatha Chinta
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mitul Patel
- Sulpizio Cardiovascular Center, University of California San Diego, San Diego, CA, USA
| | - Jad Omran
- Sharp HealthCare System, 5555 Grossmont Center Dr. La Mesa, San Diego, CA, 91942, USA.
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47
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Ibrahim WH, Ata F, Choudry H, Javed H, Shunnar KM, Shams A, Arshad A, Bosom A, Elkahlout MH, Sawaf B, Ahmed SM, Olajide T. Prevalence, Outcome, and Optimal Management of Free-Floating Right Heart Thrombi in the Context of Pulmonary Embolism, a Systematic Review and Meta-Analysis. Clin Appl Thromb Hemost 2022; 28:10760296221140114. [PMID: 36384306 PMCID: PMC9677292 DOI: 10.1177/10760296221140114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Free-floating right-heart thrombus (FFRHT) in the context of a pulmonary embolism (PE) is a rare but serious encounter with no guidelines addressing its management. We performed a systematic review and meta-analysis addressing prevalence, clinical behavior, and outcomes of FFRHT associated with PE. Among the included 397 patients with FFRHT and PE, dyspnea was the main presenting symptom (73.3%). Obstructive shock was documented in 48.9% of cases. Treatment with thrombolytic therapy, surgical thrombectomy, and percutaneous thrombectomy was documented in 43.8%, 32.7%, and 6.5% of patients, respectively. The overall mortality rate was 20.4%. Syncope ( p: 0.027), chest pain ( p: 0.006), and obstructive shock ( p: 0.037) were significantly associated with mortality. Use of thrombolytic therapy was significantly associated with survival ( p: 0.008). A multivariate logistic regression model to determine mortality predictors revealed that syncope (OR: 1.97, 95% CI: 1.06–3.65, p: 0.03), and obstructive shock (OR: 2.23, 95% CI: 1.20–4.14, p: 0.01) were associated with increased death odds. Treatment with thrombolytic therapy (OR: 0.22, 95% CI: 0.086–0.57, p: 0.002) or surgical thrombectomy (OR: 0.35, 95% CI: 0.137–0.9, p: 0.03) were associated with reduced death odds. Meta-analysis of observational studies revealed a pooled prevalence of FFRHT among all PE cases of 8.1%, and overall mortality of 23%. Although uncommon, the presence of FFRHT in the context of PE is associated with high obstructive shock and mortality rates. Favorable survival odds are observed with thrombolytic therapy and surgical thrombectomy. Data are derived from case reports and observational studies. Clinical trials elucidating these findings are needed.
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Affiliation(s)
- Wanis H. Ibrahim
- Department of Pulmonology and Internal Medicine, Weill-Cornell Medicine & Hamad General Hospital, Doha, Qatar
| | - Fateen Ata
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| | - Hassan Choudry
- Department of Respiratory Medicine, University Hospital of Leicester, Leicester, UK
| | - Huzaifa Javed
- Department of Medicine, Cavan General Hospital, Cavan, Ireland
| | - Khaled M Shunnar
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdullah Shams
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| | - Abdullah Arshad
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| | - Adel Bosom
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| | | | - Bisher Sawaf
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| | - Shahda M.A. Ahmed
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| | - Tinuola Olajide
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
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48
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Jolobe OMP. The Relevance of a Patent Foramen Ovale in a Patient with Right Atrial Thrombus. J Emerg Med 2021; 61:e126. [PMID: 34916060 DOI: 10.1016/j.jemermed.2021.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/05/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Oscar M P Jolobe
- British Medical Association, BMA, House Tavistock Square, London United Kingdom
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49
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Hulkoti V, Kamat S, Acharya S, Shukla S, Kumar S, Talwar D. Serpentine Thrombus in Right Atrium: A Tell-Tale Sign of Venous Thromboembolism. Cureus 2021; 13:e20336. [PMID: 35028228 PMCID: PMC8743344 DOI: 10.7759/cureus.20336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/15/2022] Open
Abstract
Pulmonary embolism is linked with a remarkable rate of mortality, particularly when it is associated with hemodynamic instability, right atrial thrombus and related right ventricular dysfunction. In patients affected with pulmonary embolism, thrombolysis has been documented to be life-saving. The administration of thrombolytic agents ensures early resolution of the thrombus and prevents arrhythmia and cardiogenic shock. Streptokinase, urokinase and alteplase are among the three thrombolytic agents approved for the treatment of pulmonary embolism. In emergency situations, thrombectomy plays a crucial role.
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50
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Stombaugh DK, Daubenspeck D, Chaney MA, Lu S, Fitzsimons MG, Gerlach RM. Percutaneous Vacuum-Assisted Thrombectomy for Right Atrial Mass. J Cardiothorac Vasc Anesth 2021; 36:3392-3402. [DOI: 10.1053/j.jvca.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/12/2021] [Indexed: 11/11/2022]
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