Jun 3, 1999

Free-floating thrombi in the right heart: diagnosis, management, and prognostic indexes in 38 consecutive patients

Circulation
L ChartierC Théry

Abstract

Floating right heart thrombi (FRHTS) are a rare phenomenon, encountered almost exclusively in patients with suspected or proven pulmonary embolism and diagnosed by transthoracic echocardiography. Their management remains controversial. We report on a series of 38 consecutive patients encountered over the past 12 years. Thirty-two patients were in NYHA class IV, 20 in cardiogenic shock. Echocardiography usually demonstrated signs of cor pulmonale: right ventricular overload (91.7% of the population), paradoxical interventricular septal motion (75%), and pulmonary hypertension (86. 1%). The thrombus was typically wormlike (36 of 38 patients). It extended from the left atrium through a patent foramen ovale in 4 patients. Pulmonary embolism was confirmed in all but 1. Mortality was high (17 of 38 patients) irrespective of the therapeutic option chosen: surgery (8 of 17), thrombolytics (2 of 9), heparin (5 of 8), or interventional percutaneous techniques (2 of 4). The in-hospital mortality rate was significantly linked with the occurrence of cardiac arrest. Conversely, the outcome after discharge was usually good, because 18 of 21 patients were still alive 47.2 months later (range, 1 to 70 months). Severe pulmonary embolism was the ...Continue Reading

Mentioned in this Paper

Heparin
Transthoracic Echocardiography
Pulmonary Embolism
Coronary Thrombosis
Left Atrial Structure
Atrial Function, Right
Echocardiography
2D Echocardiography
Combined Modality Therapy
Foramen Ovale, Patent

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