Treatment of Mobile Right Heart Thrombi
KeywordsMobile right heart thrombi, pulmonary embolism, half-dose alteplase
Right heart thrombi are detected in approximately 4% of patients with pulmonary embolism. The associated mortality is high, but the optimal strategy remains controversial. We report a case of a large mobile right heart thrombus, complicated by embolism of the right pulmonary artery, which was successfully treated with half-dose alteplase. We briefly review the literature and discuss the therapeutic options, focusing on the advantages of thrombolysis.
Casazza F, Becattini C, Guglielmelli E, Floriani I, Morrone V, Caponi C, et al. Prognostic significance of free-floating right heart thromboemboli in acute pulmonary embolism: results from the Italian Pulmonary Embolism Registry. Thromb Haemost 2014;111(1):53–57.
Ko? M, Kostrubiec M, Elikowski W, Meneveau N, Lankeit M, Grifoni S, et al. Outcome of patients with right heart thrombi: the Right Heart Thrombi European Registry. Eur Respir J 2016;47(3):869–875.
The European Cooperative Study on the clinical significance of right heart thrombi. European Working Group on Echocardiography. Eur Heart J 1989;10(12):1046–1059.
Rose PS, Punjabi NM, Pearse DB. Treatment of right heart thromboemboli. Chest 2002;121(3):806–814.
Burgos LM, Costabel JP, Galizia Brito V, Sigal A, Maymo D, Iribarren A, et al. Floating right heart thrombi: a pooled analysis of cases reported over the past 10 years. Am J Emerg Med 2018;36(6):911–915.
Barrios D, Chavant J, Jimenez D, Bertoletti L, Rosa-Salazar V, Muriel A, et al. Treatment of right heart thrombi associated with acute pulmonary embolism. Am J Med 2017;130(5):588–595.
Kiser TH, Burnham EL, Clark B, Ho PM, Allen RR, Moss M, et al. Half-dose versus full-dose alteplase for treatment of pulmonary embolism. Crit Care Med 2018;46(10):1617–1625.
Issue: LATEST ONLINE (view)