1
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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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2
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Andò G, Pelliccia F, Saia F, Tarantini G, Fraccaro C, D'Ascenzo F, Zimarino M, Di Marino M, Niccoli G, Porto I, Calabrò P, Gragnano F, De Rosa S, Piccolo R, Moscarella E, Fabris E, Montone RA, Spaccarotella C, Indolfi C, Sinagra G, Perrone Filardi P. Management of high and intermediate-high risk pulmonary embolism: A position paper of the Interventional Cardiology Working Group of the Italian Society of Cardiology. Int J Cardiol 2024; 400:131694. [PMID: 38160911 DOI: 10.1016/j.ijcard.2023.131694] [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: 12/10/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024]
Abstract
Pulmonary embolism (PE) is a potentially life-threatening condition that remains a major global health concern. Noteworthy, patients with high- and intermediate-high-risk PE pose unique challenges because they often display clinical and hemodynamic instability, thus requiring rapid intervention to mitigate the risk of clinical deterioration and death. Importantly, recovery from PE is associated with long-term complications such as recurrences, bleeding with oral anticoagulant treatment, pulmonary hypertension, and psychological distress. Several novel strategies to improve risk factor characterization and management of patients with PE have recently been introduced. Accordingly, this position paper of the Working Group of Interventional Cardiology of the Italian Society of Cardiology deals with the landscape of high- and intermediate-high risk PE, with a focus on bridging the gap between the evolving standards of care and the current clinical practice. Specifically, the growing importance of catheter-directed therapies as part of the therapeutic armamentarium is highlighted. These interventions have been shown to be effective strategies in unstable patients since they offer, as compared with thrombolysis, faster and more effective restoration of hemodynamic stability with a consistent reduction in the risk of bleeding. Evolving standards of care underscore the need for continuous re-assessment of patient risk stratification. To this end, a multidisciplinary approach is paramount in refining selection criteria to deliver the most effective treatment to patients with unstable hemodynamics. In conclusion, the current management of unstable patients with PE should prioritize tailored treatment in a patient-oriented approach in which transcatheter therapies play a central role.
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Affiliation(s)
- Giuseppe Andò
- Department of Clinical and Experimental Medicine, University of Messina, AOU Policlinico "Gaetano Martino", Messina, Italy
| | - Francesco Pelliccia
- Department of Cardiovascular Sciences, "La Sapienza" University, Rome, Italy.
| | - Francesco Saia
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
| | - Marco Zimarino
- Department of Neuroscience, Imaging and Clinical Sciences, "Gabriele D'Annunzio" University of Chieti-Pescara, Chieti, Italy; Department of Cardiology, "SS. Annunziata Hospital", ASL 2 Abruzzo, Chieti, Italy
| | - Mario Di Marino
- Department of Neuroscience, Imaging and Clinical Sciences, "Gabriele D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Giampaolo Niccoli
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Italo Porto
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties, University of Genoa, Genoa, Italy; Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS, Ospedale Policlinico San Martino, Genoa, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Italy; Division of Clinical Cardiology, AORN "Sant'Anna e San Sebastiano", Caserta, Italy
| | - Felice Gragnano
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Italy; Division of Clinical Cardiology, AORN "Sant'Anna e San Sebastiano", Caserta, Italy
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Elisabetta Moscarella
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Italy; Division of Clinical Cardiology, AORN "Sant'Anna e San Sebastiano", Caserta, Italy
| | - Enrico Fabris
- Cardio-thoraco-vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Rocco Antonio Montone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carmen Spaccarotella
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Gianfranco Sinagra
- Cardio-thoraco-vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
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3
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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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4
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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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5
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Aguiar JE. Thrombi in the right atrium with pulmonary embolism: About a clinical case. Rev Port Cardiol 2023; 42:929-930. [PMID: 37156415 DOI: 10.1016/j.repc.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
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6
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Mahtani AU, Thirunavukkarasu G, Patwa K, Mahmoud M, Grodman R. Visualized Embolization of Inferior Vena Cava Thrombus During the Abdominal Compression Maneuver to Evaluate for a Patent Foramen Ovale. CASE (PHILADELPHIA, PA.) 2023; 7:416-420. [PMID: 37970481 PMCID: PMC10635878 DOI: 10.1016/j.case.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
•IVC compression is an alternative to Valsalva to confirm the presence of a PFO. •A drawback of this method is reduced IVC compression in obese patients. •Use with caution in patients with low cardiac output and gastrointestinal diseases. •No complications while performing this maneuver have been reported. •We report visualized thrombus in the RA during the IVC compression maneuver.
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Affiliation(s)
- Arun Umesh Mahtani
- Department of Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, New York
| | - Ganesh Thirunavukkarasu
- Department of Cardiology, State University New York Downstate Medical Center, Brooklyn, New York
| | - Karishma Patwa
- Department of Cardiology, State University New York Downstate Medical Center, Brooklyn, New York
| | - Mahmoud Mahmoud
- Department of Radiology, Richmond University Medical Center/Mount Sinai, Staten Island, New York
| | - Richard Grodman
- Department of Cardiology, Richmond University Medical Center/Mount Sinai, Staten Island, New York
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7
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Kumar N, Flores AS, Mitchell J, Hussain N, Kumar JE, Wang J, Fitzsimons M, Dalia AA, Essandoh M, Black SM, Schenk AD, Stein E, Turner K, Sawyer TR, Iyer MH. Intracardiac thrombosis and pulmonary thromboembolism during liver transplantation: A systematic review and meta-analysis. Am J Transplant 2023; 23:1227-1240. [PMID: 37156300 DOI: 10.1016/j.ajt.2023.04.029] [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: 10/20/2022] [Revised: 04/13/2023] [Accepted: 04/27/2023] [Indexed: 05/10/2023]
Abstract
Intracardiac thrombosis and/or pulmonary thromboembolism (ICT/PE) is a rare but devastating complication during liver transplantation. Its pathophysiology remains poorly understood, and successful treatment remains a challenge. This systematic review summarizes the available published clinical data regarding ICT/PE during liver transplantation. Databases were searched for all publications reporting on ICT/PE during liver transplantation. Data collected included its incidence, patient characteristics, the timing of diagnosis, treatment strategies, and patient outcomes. This review included 59 full-text citations. The point prevalence of ICT/PE was 1.42%. Thrombi were most often diagnosed during the neohepatic phase, particularly at allograft reperfusion. Intravenous heparin was effective in preventing early-stage thrombus from progressing further and restoring hemodynamics in 76.32% of patients it was utilized for; however, the addition of tissue plasminogen activator or sole use of tissue plasminogen activator offered diminishing returns. Despite all resuscitation efforts, the in-hospital mortality rate of an intraoperative ICT/PE was 40.42%, with nearly half of these patients dying intraoperatively. The results of our systematic review are an initial step for providing clinicians with data that can help identify higher-risk patients. The clinical implications of our results warrant the development of identification and management strategies for the timely and effective treatment of these tragic occurrences during liver transplantation.
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Affiliation(s)
- Nicolas Kumar
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Antolin S Flores
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Justin Mitchell
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Julia E Kumar
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jack Wang
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Michael Fitzsimons
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Adam A Dalia
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Essandoh
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sylvester M Black
- Division of Transplantation Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Austin D Schenk
- Division of Transplantation Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Erica Stein
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Katja Turner
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Tamara R Sawyer
- Central Michigan University College of Medicine, Mt. Pleasant, Michigan, USA
| | - Manoj H Iyer
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
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8
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Domain G, Strubé C, Plourde B, Steinberg C, Sarrazin JF, Roy K, Poirier P, Philippon F. Acute transvenous pacemaker lead thrombosis early after implantation: A rare clinical scenario. Pacing Clin Electrophysiol 2023; 46:934-938. [PMID: 36550633 DOI: 10.1111/pace.14647] [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: 07/20/2022] [Revised: 11/22/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
Symptomatic thrombus formation due to a permanent pacemaker (PM) lead is a rare complication. It could be associated with serious outcome and should be suspected in patients who present with unexplained right heart failure, dyspnea, or syncope following dual-chamber PM implantation. A timely decision to perform an echocardiographic examination, followed by medical, thrombolytic, or surgical treatment can be necessary. We describe the case of an 84-year-old man who presented with syncope and hypotension a few days after PM implantation. A transesophageal echocardiography revealed a mobile mass in the right atrium attached to the pacemaker lead. Intravenous heparin allowed a complete resolution of the thrombus.
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Affiliation(s)
- Guillaume Domain
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Electrophysiology Division, Québec, Canada
| | - Camille Strubé
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Electrophysiology Division, Québec, Canada
| | - Benoit Plourde
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Electrophysiology Division, Québec, Canada
| | - Christian Steinberg
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Electrophysiology Division, Québec, Canada
| | - Jean-François Sarrazin
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Electrophysiology Division, Québec, Canada
| | - Karine Roy
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Electrophysiology Division, Québec, Canada
| | - Paul Poirier
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Electrophysiology Division, Québec, Canada
| | - François Philippon
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Electrophysiology Division, Québec, Canada
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9
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Maffei S, Paolini E, Tarsi G. Pulmonary embolism with floating thrombus in right atrium complicated by ischemic stroke during systemic fibrinolysis. J Cardiol Cases 2023; 28:4-6. [PMID: 37360835 PMCID: PMC10287940 DOI: 10.1016/j.jccase.2023.02.015] [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: 10/16/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 06/28/2023] Open
Abstract
Acute pulmonary embolism (PE) is the third most common cause of cardiovascular death in Europe. The presence of a floating thrombus in the right sections, is a life-threatening condition in which the most appropriate treatment is not well established. The management of this setting is still uncertain, particularly in cases of thrombosis straddling the patent foramen ovale (PFO). The stratification and treatment of PE do not consider the presence of intracardiac floating thrombosis. We describe the case of a female, 69-years-old, presenting to the emergency department because of sudden onset of dyspnea and pre-syncope. An echocardiogram was performed, showing a massive floating thrombus both in the right and left atrium, passing through a PFO. The patient underwent systemic thrombolysis with alteplase. After 1 h of infusion, sudden onset of left facio-brachio-crural hemiplegia occurred. An urgent cerebral angiographic computed tomography was performed with evidence of acute occlusion of the right M1 branch treated with mechanical thrombectomy. The presence of intracardiac thrombosis in both right and left cardiac chambers with involvement of the fossa ovalis added a further level of management complexity. To date, no clear therapeutic strategies are recommended in these clinical settings. Learning objective •The presence of floating thrombosis in the right sections is a life-threatening condition and could be considered in the risk stratification of pulmonary embolism•The presence of intracardiac thrombosis straddling the foramen ovale is a condition that poses additional difficulties in choosing the correct therapeutic approach during massive pulmonary embolis.
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Affiliation(s)
- Simone Maffei
- Corresponding author at: Department of Cardiology-Intensive Care Unit, Marche Nord Pesaro Hospital, 61121, Piazzale Cinelli n.1, Pesaro, Italy.
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10
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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: 0] [Impact Index Per Article: 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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11
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Khan WJ, Asif M, Nadeem I, Moeding M, Baab T, Chowdhury M. Management and Follow-Up of Biventricular Thrombi. Cureus 2023; 15:e39269. [PMID: 37342748 PMCID: PMC10279459 DOI: 10.7759/cureus.39269] [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: 05/20/2023] [Indexed: 06/23/2023] Open
Abstract
A thrombus is the most common intracardiac lesion. Isolated thrombi usually occur in the setting of ventricular dysfunction, such as a dyskinetic or hypokinetic myocardial wall, following an acute myocardial infarction (MI) or in cardiomyopathies (CM). Concurrent biventricular thrombus formation is rare. There are no clear guidelines for the treatment of biventricular thrombus. In this report, we describe our experience of the successful treatment of a case of biventricular thrombus with warfarin and rivaroxaban.
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Affiliation(s)
- Wahab J Khan
- Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
| | - Muhammad Asif
- Internal Medicine, Avera McKennan Hospital and University Health Center, Sioux Falls, USA
| | - Ifrah Nadeem
- Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
| | - Megan Moeding
- Cardiovascular Medicine, North Central Heart Institute, Sioux Falls, USA
| | - Thomas Baab
- Cardiovascular Medicine, North Central Heart Institute, Sioux Falls, USA
| | - Mohammed Chowdhury
- Cardiovascular Medicine, North Central Heart Institute, Sioux Falls, USA
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12
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Abazid RM, Tzemos N. Thrombus in Transit Entrapped Within a Patent Foramen Ovale: Role of Multimodality Imaging. CASE (PHILADELPHIA, PA.) 2023; 7:147-151. [PMID: 37123630 PMCID: PMC10147547 DOI: 10.1016/j.case.2022.12.007] [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: 05/02/2023]
Abstract
TIT is a thrombus attached to any right heart structure. Multimodality imaging is essential in patients with TIT to rule out intracardiac shunt. PFO is the most common access of paradoxical embolization in patients with TIT.
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Affiliation(s)
- Rami M. Abazid
- Correspondence: Rami M. Abazid, MD, Division of Cardiology, Department of Medicine, London Health Sciences Centre, Victoria Hospital, 800 Commissioners Road East, PO Box 5010, London, Ontario, N6A 5W9, Canada.
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13
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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
- grid.411600.2Endocrine Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran ,grid.411705.60000 0001 0166 0922Department of Family Medicine, Alborz University of Medical Science, Alborz, Iran
| | - Sepehr Gohari
- grid.411705.60000 0001 0166 0922Department of Family Medicine, Alborz University of Medical Science, Alborz, Iran ,grid.469309.10000 0004 0612 8427Student Research Center, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Hassan Ahangar
- grid.469309.10000 0004 0612 8427Department of Cardiology, Mousavi Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
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14
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Oh JK, Park JH. Role of echocardiography in acute pulmonary embolism. Korean J Intern Med 2023:kjim.2022.273. [PMID: 36587934 DOI: 10.3904/kjim.2022.273] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/28/2022] [Indexed: 01/03/2023] Open
Abstract
Although pulmonary embolism (PE)-related mortality rate has decreased because of prompt diagnosis and effective therapy use, acute PE remains a potentially lethal disease. Due to its increasing prevalence, clinicians should pay attention to diagnosing and managing patients with acute PE. Echocardiography is the most commonly used method for diagnosing and managing acute PE; it also provides clues about hemodynamic instability in an emergency situation. It has been validated in the early risk stratification and impacts management strategies for treating acute PE. In hemodynamically unstable patients with acute PE, echocardiographic detection of right ventricular dysfunction is an indication for administering thrombolytics. In this review article, we discuss the role of echocardiography in the diagnosis and management of patients with acute PE.
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Affiliation(s)
- Jin Kyung Oh
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Korea
| | - Jae-Hyeong Park
- Department of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
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15
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [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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16
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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 2022; 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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17
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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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18
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PaceMaker lead and atrial thrombosis, a rare event but of high clinical importance. COR ET VASA 2022. [DOI: 10.33678/cor.2021.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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19
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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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20
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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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21
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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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22
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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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23
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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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24
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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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25
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Stefan M, Rimbas RC, Vornicu R, Daneţ R, Vintila VD, Dorobat B, Carp A, Dragos V. Uma Luta Passo a Passo pela Vida em uma Jovem com Embolismo Pulmonar de Alto Risco e Oclusão Bilateral da Artéria Renal. Arq Bras Cardiol 2022; 118:530-535. [PMID: 35262592 PMCID: PMC8856696 DOI: 10.36660/abc.20210189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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26
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Mustafa A, Obholz J, Ghanim M, Congello S. Clot in Transit: Therapy via Peripherally Inserted Central Catheter Line. Cureus 2022; 14:e21691. [PMID: 35237484 PMCID: PMC8882343 DOI: 10.7759/cureus.21691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 11/05/2022] Open
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27
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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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28
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Umar H, Zagga UM, Akintomide FA, Aminu A, Maiyaki AS, Zulkifilu U, Umar MT, Muhammad KM, Yusuf AA, Bamaiyi AJ. Triple emergencies: Hyperosmolar hyperglycemic state, venous thromboembolism, and huge free-floating right heart thrombus successfully managed with anticoagulation. Clin Case Rep 2021; 9:e04710. [PMID: 34963797 PMCID: PMC8710849 DOI: 10.1002/ccr3.4710] [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: 08/14/2020] [Revised: 04/28/2021] [Accepted: 07/30/2021] [Indexed: 11/18/2022] Open
Abstract
A 57-year-old man, with type 2 diabetes mellitus, was admitted with a hyperosmolar hyperglycemic state, who developed in-hospital venous thromboembolism with huge free-floating right heart thrombus, and there is no available optimal treatment option for the huge free-floating right heart thrombus, except anticoagulation with warfarin and low molecular weight heparin with successful outcome.
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Affiliation(s)
- Hayatu Umar
- Department of Internal MedicineUsmanu Danfodiyo University Teaching Hospital, Usmanu Danfodiyo UniversitySokotoNigeria
| | - Usman Muawiyya Zagga
- Department of Internal MedicineUsmanu Danfodiyo University Teaching Hospital, Usmanu Danfodiyo UniversitySokotoNigeria
| | - Femi Akindotun Akintomide
- Department of Internal MedicineUsmanu Danfodiyo University Teaching Hospital, Usmanu Danfodiyo UniversitySokotoNigeria
| | - Abdulaziz Aminu
- Department of Internal MedicineUsmanu Danfodiyo University Teaching Hospital, Usmanu Danfodiyo UniversitySokotoNigeria
| | - Abubakar S. Maiyaki
- Department of Internal MedicineUsmanu Danfodiyo University Teaching Hospital, Usmanu Danfodiyo UniversitySokotoNigeria
| | - Umar Zulkifilu
- Department of Internal MedicineUsmanu Danfodiyo University Teaching Hospital, Usmanu Danfodiyo UniversitySokotoNigeria
| | - Musa Tambuwal Umar
- Department of Internal MedicineUsmanu Danfodiyo University Teaching Hospital, Usmanu Danfodiyo UniversitySokotoNigeria
| | - Kabiru Mande Muhammad
- Department of Internal MedicineUsmanu Danfodiyo University Teaching Hospital, Usmanu Danfodiyo UniversitySokotoNigeria
| | - Adeshina Abdulateef Yusuf
- Department of Internal MedicineUsmanu Danfodiyo University Teaching Hospital, Usmanu Danfodiyo UniversitySokotoNigeria
| | - Adamu Jibril Bamaiyi
- Department of Physiology, Faculty of Clinical sciencesUsmanu Danfodiyo UniversitySokotoNigeria
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29
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Atici A, Asoglu R, Demirkiran A, Demir AA, Barman HA, Cevik E, Dursun M, Bugra MZ. Impact of Multimodality Imaging on the Diagnosis of Left Ventricular Apical Thrombus in Patients after Anterior Myocardial Infarction. Am J Med Sci 2021; 363:130-139. [PMID: 34848187 DOI: 10.1016/j.amjms.2021.06.028] [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: 07/22/2020] [Revised: 03/12/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The presence of the left ventricle (LV) apical thrombus is one of the most critical complications of anterior myocardial infarction (MI). Due to the high risk of systemic embolization, the determination of LV apical thrombus (LVAT) is essential. We aimed to compare the two-dimensional echocardiography (2DE), contrast-2DE and real-time three-dimensional echocardiography (RT-3DE) in the diagnosis of LVAT and determine which imaging modality is superior. METHODS The study was designed as a prospective cohort study, and 161 patients were included. Patients with low ejection fraction (<40%) and LV apical wall motion abnormality (severe hypokinetic, akinetic or dyskinetic) were included. 2DE, contrast-2DE, RT-3DE, and magnetic resonance imaging (MRI) were performed on all patients within one month after anterior MI. RESULTS Transthoracic 2DE detected thrombi in 29 patients, contrast-2DE detected thrombi in 33 patients, RT-3DE detected thrombi in 32 patients, and MRI detected thrombi in 28 patients. While MRI is accepted as the gold standard for non-invasive imaging, the specificity of detecting thrombus with 2DE is 90%, and the sensitivity is 57%, contrast-2DE had 82% sensitivity and 92% specificity for the detection of LVAT. The specificity for detecting thrombus with RT-3DE is 93%, and the sensitivity is 85%. Accuracy was 84%, 90% and 92% with 2DE, contrast-2DE and RT-3DE, respectively. CONCLUSIONS We found that RT-3DE was more sensitive and more specific than 2DE and contrast-2DE in the diagnosis of LVAT. The diagnostic accuracy of RT-3DE was higher than 2DE and contrast-2DE for LVAT.
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Affiliation(s)
- Adem Atici
- Cardiology Department, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.
| | - Ramazan Asoglu
- Adiyaman Health Education and Research Hospital, Department of Cardiology, Adiyaman, Turkey
| | - Ahmet Demirkiran
- Cardiology Department, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ali Aslan Demir
- Radiology Department, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Hasan Ali Barman
- Istanbul University - Cerrahpasa, Institute of Cardiology, Department of Cardiology, Istanbul, Turkey
| | - Erdem Cevik
- Cardiology Department, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Memduh Dursun
- Radiology Department, Istanbul Faculty of Medicine, Istanbul, Turkey
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30
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Aroke D, Nnaoma CB, Nubong TF, Okoye OC, Visveswaran G. Right Atrial Thrombi, the Management Conundrum: 2 Case Reports. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933427. [PMID: 34793412 PMCID: PMC8609977 DOI: 10.12659/ajcr.933427] [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] [Indexed: 11/09/2022]
Abstract
Case series
Patients: Male, 62-year-old • Male, 66-year-old
Final Diagnosis: Right atrial floating thrombus • right heart thrombus-in-transit
Symptoms: Shortness of breath
Medication: —
Clinical Procedure: —
Specialty: Cardiology
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Affiliation(s)
- Desmond Aroke
- Department of Internal Medicine, Newark Beth Israel Medical Center, Newark, NJ, USA
| | | | - Thomas F Nubong
- Department of Internal Medicine, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Okechukwu C Okoye
- Department of Internal Medicine, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Gautam Visveswaran
- Department of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
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31
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Han K, Huang MQ, Deng X, Shang YC. Remaining Vigilant to Paradoxical Air Embolism in Patients Undergoing Hysteroscopic Surgery: A Case Report and Review of the Literature. J Perianesth Nurs 2021; 36:606-611. [PMID: 34740530 DOI: 10.1016/j.jopan.2021.03.011] [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: 12/07/2020] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 10/19/2022]
Abstract
The purpose of this case study and review was to understand the perianesthestic care of paradoxical air embolism (PAE) in patients undergoing hysteroscopic surgery. The perianesthestic management record of a patient undergoing hysteroscopic surgery was analyzed to study the characteristics of PAE, and the literature describing the perianesthestic care for PAE was reviewed. The first symptom of PAE in hysteroscopic surgery is often a decrease in end-tidal carbon dioxide (ETCO2), and the complications include embolism of the pulmonary artery, coronary artery, and cerebral artery. The best monitoring method is continuous ETCO2 monitoring, and intraoperative echocardiography is an excellent method to diagnose and guide the treatment of PAE. PAE is a rare but serious complication of hysteroscopic surgery that is associated with organ ischemia and hypoxia. Prevention and treatment of PAE requires the vigilance and cooperation of not only perianesthesia nurses and anesthesiologists but also the surgeons and operating room nurses. Early prevention, proper monitoring, and effective treatment are the keys to successful rescue for PAE.
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Affiliation(s)
- Kun Han
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
| | - Man-Qiu Huang
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Xi Deng
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yu-Chao Shang
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
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32
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Yu T, Yang EH, Ranade M. AngioVac aspiration of right atrial cardiac pacemaker lead-associated thrombus with concurrent PE under fluoroscopic and transesophageal echocardiographic guidance: a multidisciplinary collaboration for improved patient outcome. Clin Imaging 2021; 81:33-36. [PMID: 34598001 DOI: 10.1016/j.clinimag.2021.08.017] [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: 06/22/2021] [Revised: 07/21/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
In the U.S., pulmonary embolism (PE) is a common cause of cardiovascular death. Right heart thrombus (RHT) occurs in approximately 4% of patients with PE, and when concurrent is associated with increased 30-day PE-related and all-cause mortality. The consensus on optimal management of acute massive or high-risk PE is unclear, and even less so for concurrent RHT. In this report, we review a successful multidisciplinary coordination of vacuum-assisted thrombectomy (VAT) of a complex pacemaker lead-associated RHT in a patient with concurrent acute PE and significant comorbidities, using the AngioVac system (Vortex Medical, Norwell, MA). VAT is a reasonable treatment option that should be considered particularly for patients who are poor surgical or thrombolytic candidates. Procedural success and patient outcomes can be further optimized through multidisciplinary collaboration such as with the Pulmonary Embolism Response Team (PERT) model.
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Affiliation(s)
- Tiffany Yu
- Department of Radiological Sciences, University of California at Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095, United States of America.
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095, United States of America.
| | - Mona Ranade
- Department of Radiological Sciences, University of California at Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095, United States of America.
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33
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Barbagallo M, Naef D, Köpfli P, Hufschmid U, Niemann T, Gebker R, Beer JH, Hireche-Chiakoui H. Right ventricular thrombus, a challenge in imaging diagnostics: a case series. Eur Heart J Case Rep 2021; 5:ytab340. [PMID: 34622134 PMCID: PMC8491024 DOI: 10.1093/ehjcr/ytab340] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/05/2021] [Accepted: 08/05/2021] [Indexed: 11/15/2022]
Abstract
Background Presence of right ventricular thrombus (RVT) is a rare but life-threatening condition, thus immediate diagnosis and therapy are mandatory. Unfortunately, detection and distinction from intraventricular tumour masses or vegetations represent a complex task. Furthermore, consecutive therapy is principally led by clinical presentation without considering morphological features of the thrombus. Current literature suggests a multimodal non-invasive imaging approach. In this article, we discuss the role of cardiac magnetic resonance imaging (CMR) for the detection of RVT in patients with pulmonary embolism (PE). We consider the relatively expensive and not broadly available imaging procedure and weigh it up to its assumed high sensitivity, specificity, and importance for differential diagnosis and therapeutic decision-making. Case summary In this case series, we report three cases of RVT with concomitant PE, whereof two were missed during routine cardiac workup by transthoracic echocardiography and computer tomography. Cardiac magnetic resonance imaging led to detection and further characterization of the thrombi in both cases. Conclusions Cardiac magnetic resonance imaging reliably detects and characterizes RVT, even under unfavourable conditions for echocardiography such as arrhythmia, adiposity, or in posterior position of RVT. Obtained information could facilitate the choice of therapeutic approach (anticoagulation vs. systemic lysis vs. surgical thrombectomy). Future risk stratification scores will promote cost-effective use of CMR.
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Affiliation(s)
- Massimo Barbagallo
- Department of Internal Medicine, Cantonal Hospital of Baden, Im Ergel 1, CH-5404 Baden, Switzerland
| | - Daryl Naef
- Department of Internal Medicine, Cantonal Hospital of Baden, Im Ergel 1, CH-5404 Baden, Switzerland
| | - Pascal Köpfli
- Department of Internal Medicine, Cantonal Hospital of Baden, Im Ergel 1, CH-5404 Baden, Switzerland
| | - Urs Hufschmid
- Department of Internal Medicine, Cantonal Hospital of Baden, Im Ergel 1, CH-5404 Baden, Switzerland
| | - Tilo Niemann
- Department of Radiology, Cantonal Hospital of Baden, Im Ergel 1, CH-5404 Baden, Switzerland
| | | | - Jürg Hans Beer
- Department of Internal Medicine, Cantonal Hospital of Baden, Im Ergel 1, CH-5404 Baden, Switzerland
- Center for Molecular Cardiology, University of Zurich, Zurich Switzerland
| | - Hanane Hireche-Chiakoui
- Department of Internal Medicine, Cantonal Hospital of Baden, Im Ergel 1, CH-5404 Baden, Switzerland
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34
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Callese TE, O'Brien DP, Wilhalme H, Yang EH, Moriarty JM. AngioVac Aspiration Thrombectomy of Right Atrial Thrombus is Safe and Effective in Cancer Patients. Ann Vasc Surg 2021; 77:243-254. [PMID: 34437971 DOI: 10.1016/j.avsg.2021.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/16/2021] [Accepted: 05/24/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to test the hypothesis that endovascular aspiration thrombectomy of right atrial thrombus (RAT) using the AngioVac device is as safe and effective in patients with cancer as those without cancer. BACKGROUND RAT is a uniquely challenging clinical presentation of venous thromboembolism due to its low incidence and historically high-risk of mortality due to thrombus propagation into the pulmonary arteries. There is a lack of consensus regarding management, particularly in high-risk cancer patients. Endovascular aspiration thrombectomy utilizing the AngioVac device is effective in removal of right atrial thrombus and may be a safer option for patients with cancer in whom avoidance of higher-risk intervention is preferred. METHODS This was an institutional review board-approved retrospective single-center case control study of patients with RAT who underwent AngioVac aspiration thrombectomy between August 2013 and July 2020. Analysis of patient demographics and clinical characteristics, thrombus-related factors, and operative details was performed. Primary endpoints included survival, safety, and technical success. RESULTS A total of 44 patients met inclusion criteria, 20 of whom with active malignancy. The oncology group had a significantly higher Charlson comorbidity index (P = 0.01). Comparative outcomes between the oncology and non-oncology group showed no difference in survival (P = 0.8) or technical success (OR 3, 95% CI 0.83-10.9). There were 9 complications, including 6 minor, 1 moderate, 1 severe, and 1 death. CONCLUSIONS AngioVac aspiration thrombectomy of RAT is as safe and effective in patients with cancer as those without cancer.
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Affiliation(s)
- Tyler E Callese
- Department of Radiology, Division of Interventional Radiology, University of California at Los Angeles, Los Angeles, CA.
| | - Daniel P O'Brien
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Holly Wilhalme
- Department of Medicine, Division of General Internal Medicine and Health Services Research, Los Angeles, CA
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - John M Moriarty
- Department of Radiology, Division of Interventional Radiology, University of California at Los Angeles, Los Angeles, CA
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35
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Yang YC, Chen YY. Right heart thrombus-in-transit in a patient with Evans syndrome: A case report. Medicine (Baltimore) 2021; 100:e27009. [PMID: 34414994 PMCID: PMC8376335 DOI: 10.1097/md.0000000000027009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/05/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Right heart free-floating thrombus in the absence of structural heart disease or atrial fibrillation is rare. When it travels to the heart into the lung, called thrombus-in-transit, may cause cardiopulmonary collapse and sudden death. The clinical presentation varies from mild respiratory symptoms to sudden death; however, there are few clinical case reports of giant, free-floating thrombus in the right heart in an asymptomatic patient, and the optimal management options have not been established. PATIENT CONCERNS A 36-year-old Asian woman presented to the emergency department with complaints of worsening swelling of the left lower extremity over 12 hours. DIAGNOSIS Left leg deep vein thrombosis accompanied by an asymptomatic giant right atrial thrombus and pulmonary embolism with a rare autoimmune disease of Evans syndrome. INTERVENTIONS Emergent surgical thrombectomy under cardiopulmonary bypass for right atrial thrombus. OUTCOMES The postoperative course was uneventful, and she was discharged on the eighth postoperative day with normal heart function and mild tricuspid regurgitation. CONCLUSION An additional diagnostic workup in cases of deep vein thrombosis is necessary for the rapid diagnosis of right heart thrombus and pulmonary embolism without delay. This case report illustrates that early recognition of venous thromboembolism and emergent thrombectomy of right heart thrombus-in-transit is crucial to prevent mortality.
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Affiliation(s)
- Ya-Chen Yang
- Kaohsiung Chang Gung Memorial Hospital Education Department, Kaohsiung, Taiwan
| | - Yen-Yu Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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36
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Cohen A, Donal E, Delgado V, Pepi M, Tsang T, Gerber B, Soulat-Dufour L, Habib G, Lancellotti P, Evangelista A, Cujec B, Fine N, Andrade MJ, Sprynger M, Dweck M, Edvardsen T, Popescu BA. EACVI recommendations on cardiovascular imaging for the detection of embolic sources: endorsed by the Canadian Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2021; 22:e24-e57. [PMID: 33709114 DOI: 10.1093/ehjci/jeab008] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/07/2021] [Indexed: 12/28/2022] Open
Abstract
Cardioaortic embolism to the brain accounts for approximately 15-30% of ischaemic strokes and is often referred to as 'cardioembolic stroke'. One-quarter of patients have more than one cardiac source of embolism and 15% have significant cerebrovascular atherosclerosis. After a careful work-up, up to 30% of ischaemic strokes remain 'cryptogenic', recently redefined as 'embolic strokes of undetermined source'. The diagnosis of cardioembolic stroke remains difficult because a potential cardiac source of embolism does not establish the stroke mechanism. The role of cardiac imaging-transthoracic echocardiography (TTE), transoesophageal echocardiography (TOE), cardiac computed tomography (CT), and magnetic resonance imaging (MRI)-in the diagnosis of potential cardiac sources of embolism, and for therapeutic guidance, is reviewed in these recommendations. Contrast TTE/TOE is highly accurate for detecting left atrial appendage thrombosis in patients with atrial fibrillation, valvular and prosthesis vegetations and thrombosis, aortic arch atheroma, patent foramen ovale, atrial septal defect, and intracardiac tumours. Both CT and MRI are highly accurate for detecting cavity thrombosis, intracardiac tumours, and valvular prosthesis thrombosis. Thus, CT and cardiac magnetic resonance should be considered in addition to TTE and TOE in the detection of a cardiac source of embolism. We propose a diagnostic algorithm where vascular imaging and contrast TTE/TOE are considered the first-line tool in the search for a cardiac source of embolism. CT and MRI are considered as alternative and complementary tools, and their indications are described on a case-by-case approach.
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Affiliation(s)
- Ariel Cohen
- Assistance Publique-Hôpitaux de Paris, Saint-Antoine and Tenon Hospitals, Department of Cardiology, and Sorbonne University, Paris, France.,INSERM unit UMRS-ICAN 1166; Sorbonne-Université, Paris, France
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, 20141, Milan, Italy
| | - Teresa Tsang
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bernhard Gerber
- Service de Cardiologie, Département Cardiovasculaire, Cliniques Universitaires St. Luc, Division CARD, Institut de Recherche Expérimental et Clinique (IREC), UCLouvainAv Hippocrate 10/2803, B-1200 Brussels, Belgium
| | - Laurie Soulat-Dufour
- Assistance Publique-Hôpitaux de Paris, Saint-Antoine and Tenon Hospitals, Department of Cardiology, and Sorbonne University, Paris, France.,INSERM unit UMRS-ICAN 1166; Sorbonne-Université, Paris, France
| | - Gilbert Habib
- Aix Marseille Univ, IRD, MEPHI, IHU-Méditerranée Infection, APHM, La Timone Hospital, Cardiology Department, Marseille, France
| | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Sciences, Department of Cardiology, CHU SartTilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Arturo Evangelista
- Servei de Cardiologia. Hospital Universitari Vall d'Hebron-VHIR. CIBER-CV. Pº Vall d'Hebron 119. 08035. Barcelona. Spain
| | - Bibiana Cujec
- Division of Cardiology, University of Alberta, 2C2.50 Walter Mackenzie Health Sciences Center, 8440 112 St NW, Edmonton, Alberta, Canada T6G 2B7
| | - Nowell Fine
- University of Calgary, Libin Cardiovascular Institute, South Health Campus, 4448 Front Street Southeast, Calgary, Alberta T3M 1M4, Canada
| | - Maria Joao Andrade
- Maria Joao Andrade Cardiology Department, Hospital de Santa Cruz-Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos 2790-134 Carnaxide, Portugal
| | - Muriel Sprynger
- Department of Cardiology-Angiology, University Hospital Liège, Liège, Belgium
| | - Marc Dweck
- British Heart Foundation, Centre for Cardiovascular Science, Edinburgh and Edinburgh Imaging Facility QMRI, University of Edinburgh, United Kingdom
| | - Thor Edvardsen
- Faculty of medicine, Oslo University, Oslo, Norway and Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Bogdan A Popescu
- Cardiology Department, University of Medicine and Pharmacy 'Carol Davila', Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Sos. Fundeni 258, sector 2, 022328 Bucharest, Romania
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37
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Yan W, Gunther I, Hafiz A, Goldenberg R. Submassive pulmonary embolism with a right heart thrombus. BMJ Case Rep 2021; 14:14/7/e242092. [PMID: 34290009 DOI: 10.1136/bcr-2021-242092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 49-year-old woman presented to the hospital with shortness of breath 2 weeks after a left total hip replacement. She was found to have a submassive pulmonary embolism (PE), with her case complicated by the detection of a large mobile clot in transit extending through a patent foramen ovale between the right and left atria. The presence of this free-floating right heart thrombus (FFRHT) increases her risks of stroke and mortality, yet the optimal approach to her treatment was unclear. Ultimately, intravenous tissue plasminogen activator was administered with resolution of the clot. Treatment was complicated by haemodynamically insignificant bleeding at the site of recent surgery. Herein, we further discuss the implications and treatment options for patients with an FFRHT in the setting of an acute PE.
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Affiliation(s)
- Winnie Yan
- Critical Care Medicine, NYU Langone Health, New York, New York, USA
| | - Ingrid Gunther
- Critical Care Medicine, NYU Langone Health, New York, New York, USA
| | - Ali Hafiz
- Critical Care Medicine, NYU Langone Health, New York, New York, USA
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38
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Denault AY, Roberts M, Cios T, Malhotra A, Paquin SC, Tan S, Cavayas YA, Desjardins G, Klick J. Transgastric Abdominal Ultrasonography in Anesthesia and Critical Care: Review and Proposed Approach. Anesth Analg 2021; 133:630-647. [PMID: 34086617 DOI: 10.1213/ane.0000000000005537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The use of transesophageal echocardiography (TEE) in the operating room and intensive care unit can provide invaluable information on cardiac as well as abdominal organ structures and function. This approach may be particularly useful when the transabdominal ultrasound examination is not possible during intraoperative procedures or for anatomical reasons. This review explores the role of transgastric abdominal ultrasonography (TGAUS) in perioperative medicine. We describe several reported applications using 10 views that can be used in the diagnosis of relevant abdominal conditions associated with organ dysfunction and hemodynamic instability in the operating room and the intensive care unit.
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Affiliation(s)
- André Y Denault
- From the Department of Anesthesiology and Critical Care Medicine, Montreal Heart Institute, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Michael Roberts
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, Milton S. Hershey Penn State Medical Center, Penn State University School of Medicine, Hershey, Pennsylvania
| | - Theodore Cios
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, Milton S. Hershey Penn State Medical Center, Penn State University School of Medicine, Hershey, Pennsylvania
| | - Anita Malhotra
- From the Department of Anesthesiology and Critical Care Medicine, Montreal Heart Institute, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Sarto C Paquin
- Department of Medicine, Division of Gastroenterology, Centre Hospitalier de l'Université de Montréal (CHUM)
| | - Stéphanie Tan
- Department of Radiology, Montreal Heart Institute, Université de Montréal
| | - Yiorgos Alexandros Cavayas
- Department of Medicine and Intensive Care Unit, Montreal Sacré-Coeur Hospital and Department of Medicine and Intensive Care Unit, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Georges Desjardins
- From the Department of Anesthesiology and Critical Care Medicine, Montreal Heart Institute, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - John Klick
- Department of Anesthesiology, University of Vermont Medical Center, Larner College of Medicine, University of Vermont, Burlington, Vermont
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Verma I, Chang EY, Kumar G, Sachdeva R. Catheter directed embolectomy of right atrial clot in transit-A case series. Catheter Cardiovasc Interv 2021; 97:869-873. [PMID: 33226187 DOI: 10.1002/ccd.29391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/12/2020] [Accepted: 11/09/2020] [Indexed: 11/08/2022]
Abstract
In the previous literature, the prevalence of right atrial (RA) clot-in-transit associated with pulmonary embolism is around 4-18% with an associated mortality of 80-100% in untreated cases. Surgical thrombo-embolectomy has been the mainstay of treatment for stable patients but the data for percutaneous thrombo-embolectomy is lacking in the literature. We present a series of three cases of right atrium clot-in-transit treated with catheter-based therapies with Inari FlowTriever® (Inari Medical, Irvine, CA). Our three patients had different clinical profiles and presentations of right atrial clot-in-transit. All of the subjects had contraindications to surgical thrombo-embolectomy and thrombolytic therapy. Catheter based embolectomy using Inari FlowTriever® was successfully performed in all the patients. As the data on this intervention is sparse, our case series highlights successful catheter based thrombo-embolectomies in high-risk individuals with right atrial clot in-transit with or without pulmonary embolism.
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Affiliation(s)
- Isha Verma
- Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, USA.,Division of Cardiology, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Eric Y Chang
- Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, USA.,Division of Cardiology, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Gautam Kumar
- Division of Cardiology, Atlanta Veterans Affairs Hospital, Decatur, Georgia, USA.,Division of Cardiology, Grady Memorial Hospital, Atlanta, Georgia, USA.,Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rajesh Sachdeva
- Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, USA.,Division of Cardiology, Atlanta Veterans Affairs Hospital, Decatur, Georgia, USA.,Division of Cardiology, Grady Memorial Hospital, Atlanta, Georgia, USA
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40
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Muramoto H, Niwa A, Satoh Y, Onishi T, Kobayashi I, Onishi Y, Harada N, Musha T. Clinical Significance and Prognosis of Right Heart Thrombi Associated With Acute Pulmonary Thromboembolism - Results of a Multicenter Registry of Thrombolysis in Japan. Circ J 2021; 85:353-360. [PMID: 33408303 DOI: 10.1253/circj.cj-20-0501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Thrombolytic therapy is standard treatment in acute pulmonary thromboembolism (PTE) with hemodynamic instability. Although right heart thrombi (RHT) appear to increase mortality in acute PTE, large-scale studies of acute PTE with RHT are scarce.Methods and Results:Patient data (from August 2005 to May 2014) obtained from post-marketing surveillance of thrombolytic therapy using a tissue-type plasminogen activator were analyzed retrospectively. Of the 2,698 confirmed cases of acute PTE who underwent echocardiographic assessment, 166 (6.2%) were diagnosed with RHT. PTE patients with RHT, compared with those without RHT, had higher rates of mortality (20.2% vs. 10.4%, P<0.001), hemodynamic instability (53.0% vs. 37.7%, P<0.001), and PTE recurrence (6.6% vs. 2.3%, P=0.003). When considering PTE-related hemodynamic severity (cardiopulmonary arrest/collapse, massive, submassive, and non-massive), mortality was significantly higher in patients with RHT in the massive (19.8% vs. 7.7%, P=0.002) and submassive (8.0% vs. 2.8%, P=0.018) groups, whereas no significant differences was found between those with and without RHT in the cardiopulmonary arrest/collapse (51.7% vs. 52.1%, P=0.960) and non-massive (1.6% vs. 0%, P=0.596) groups. CONCLUSIONS PTE patients with RHT had higher mortality, severity, and PTE recurrence rates. RHT was particularly associated with worse outcomes in patients with massive or submassive PTE.
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Affiliation(s)
| | - Akihiro Niwa
- Department of Cardiology, Hiratsuka Kyosai Hospital
| | | | | | | | - Yuko Onishi
- Department of Cardiology, Hiratsuka Kyosai Hospital
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Fath AR, Eldaly AS, Aglan A, Varkoly KS, Beladi RN, Solsi A, Hahn MF, Karis JP, Nafisi S, Brady K, Bellamkonda P, Wakefield DN, Clapp WL, Lucas AR. Incidental Finding of a Large Right Atrial Thrombus in a Patient With Cerebral Lymphoma. J Investig Med High Impact Case Rep 2021; 9:23247096211001636. [PMID: 33749363 PMCID: PMC7985942 DOI: 10.1177/23247096211001636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Right atrial (RA) masses are rare, challenging to diagnose, and potentially life-threatening with high mortality if untreated. We present a patient presenting with diffuse large B-cell lymphoma in the brain that was incidentally found to have a large RA mass. For a better definition of the RA mass, extensive workup using multimodality imaging including chest computed tomography, transthoracic echocardiography, transesophageal echocardiography, cardiac magnetic resonance imaging, and left heart catheterization was warranted. The imaging demonstrated a large RA mass extending through the tricuspid valve into the right ventricle and superior and inferior vena cava without a mobile component. The mass was then successfully resected, and further histology examination was performed to rule out lymphoma and rare subtypes of diffuse large B-cell lymphoma. The comprehensive workup proved the RA mass to be a calcified thrombus rather than a direct metastatic spread of lymphoma.
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Affiliation(s)
| | | | - Amro Aglan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | | | | | - Mary F Hahn
- St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | | | | | | | | | | | | | - Alexandra R Lucas
- Creighton University, Phoenix, AZ, USA.,Dignity Health, Phoenix, AZ, USA.,Arizona State University, Tempe, AZ, USA
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Hashimoto T, Sato O, Deguchi J. "Laundry dryer" sign associated with venous thromboembolism. Asian Cardiovasc Thorac Ann 2021; 29:854-855. [PMID: 33691538 DOI: 10.1177/02184923211001678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Takuya Hashimoto
- Department of Vascular Surgery, 26381Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Osamu Sato
- Department of Vascular Surgery, 26381Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Juno Deguchi
- Department of Vascular Surgery, 26381Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
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Kataoka M, Yoshizawa H, Kobayashi K, Sakurai K, Matsuno K, Tamura Y, Morita S, Maeda H, Yoshida KI. Unexpected death of a middle-aged man with severe pectus excavatum in association with pulmonary emboli. HUMAN PATHOLOGY: CASE REPORTS 2021. [DOI: 10.1016/j.ehpc.2021.200483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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44
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Silaev AA, Epifanov SI, Shcherbatiuk KV, Kolomeĭchenko NA, Dvorianchikova VA, Avrusina EK. [Hybrid treatment of total thrombosis of the inferior vena cava]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2020; 26:63-69. [PMID: 33332307 DOI: 10.33529/angio2020420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Described in the article is a clinical case report regarding successful surgical treatment of a female patient with total floating thrombosis of the inferior vena cava and thrombosis of the right atrium, complicated by pulmonary embolism. Our patient was a 42-year-old woman presenting with a clinical pattern of iliofemoral thrombosis. The examination revealed floating thrombosis of the inferior venal cava, right atrial thrombosis, and massive pulmonary embolism. Given the presence of absolute contraindications to systemic thrombolysis, it was decided to carry out surgical treatment by means of a hybrid-operation procedure. The woman underwent successful direct thrombectomy from the right-atrium cavity and branches of the pulmonary artery in conditions of artificial blood circulation, simultaneously accompanied by removing the floating thrombus from the inferior vena cava with the help of the 'Track' system, as well as by placement of a cava filter. Also presented herein is a review of the world experience gained in treating this pathology, followed by substantiation of using a hybrid approach for achieving an optimal clinical outcome.
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Affiliation(s)
- A A Silaev
- Clinical Hospital of the Presidential Administration of the Russian Federation, Moscow, Russia
| | - S Iu Epifanov
- Clinical Hospital of the Presidential Administration of the Russian Federation, Moscow, Russia
| | - K V Shcherbatiuk
- Clinical Hospital of the Presidential Administration of the Russian Federation, Moscow, Russia
| | - N A Kolomeĭchenko
- Clinical Hospital of the Presidential Administration of the Russian Federation, Moscow, Russia
| | - V A Dvorianchikova
- Clinical Hospital of the Presidential Administration of the Russian Federation, Moscow, Russia
| | - E K Avrusina
- Clinical Hospital of the Presidential Administration of the Russian Federation, Moscow, Russia
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Alhashmi JM, Elhoufi AM, Elhatou E, Ghanaim M. Disseminated Thrombosis in COVID-19 Cases: The Role of Early Antithrombotic Treatments? DUBAI MEDICAL JOURNAL 2020. [PMCID: PMC7802120 DOI: 10.1159/000509906] [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] [Indexed: 12/02/2022] Open
Abstract
Many newly published articles have focused on the association between COVID-19 and thrombogenicity. Indeed, it has become a frequently observed phenomena. In this study, we report on a 45-year-old man with a COVID-19-positive test. His dramatic progression started 5 days after admission. He developed a right ventricular (RV) thrombus (rare condition) and multiple brain sites infarction. We discuss this phenomena by showing the extent to which the thrombosis can take place, the possible relation between inflammatory, D-dimer and case progression and suggest a treatment approach particularly in cases with multiple thrombogenicity organ involvement.
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Affiliation(s)
- Jasem Mohammed Alhashmi
- Cardiology Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
- Warsan Hospitality Care Center, Dubai, United Arab Emirates
- *Jasem Mohammed Alhashmi, Consultant and Head of Cardiology Department, Dubai Hospital, Dubai Health Authority, Al Khaleej Street, Al Baraha, PO Box 7272 Dubai (UAE),
| | - Ashraf M. Elhoufi
- Intensive Care Section, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Eman Elhatou
- Cardiology Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Mahmood Ghanaim
- Emergency Section, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
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Multiple Intracardiac and Paradoxical Thrombi Caused by a Thrombus Entrapped in a Patent Foramen Ovale. Can J Cardiol 2020; 36:1978.e5-1978.e8. [DOI: 10.1016/j.cjca.2020.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/10/2020] [Accepted: 08/25/2020] [Indexed: 11/24/2022] Open
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47
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Gilliland S, Latham GJ, Kertai MD, Weitzel N. The New Normal as Life Goes on Under COVID-19. Semin Cardiothorac Vasc Anesth 2020; 24:283-286. [PMID: 33166231 DOI: 10.1177/1089253220969248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Gregory J Latham
- Seattle Children's Hospital, Seattle, WA, USA.,University of Washington Medical Center, Seattle, WA, USA
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Mayà-Casalprim G, Rodríguez-Vázquez A, Sarto J, Llull L. Trombo flotante en cavidades cardíacas derechas causante de embolismo pulmonar en paciente con ictus isquémico agudo. Caso clínico y revisión de la literatura. Neurologia 2020; 35:661-663. [DOI: 10.1016/j.nrl.2019.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/07/2019] [Accepted: 08/01/2019] [Indexed: 11/26/2022] Open
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49
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Mayà-Casalprim G, Rodríguez-Vázquez A, Sarto J, Llull L. Floating right heart thrombus causing pulmonary embolism in a patient with acute ischaemic stroke: A case report and review of literature. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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50
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Kalivoda EJ, Rivera Rodriguez K, Cabrera G. Right Heart Thrombus in Transit Diagnosed With Focused Cardiac Ultrasound in the Emergency Department. Cureus 2020; 12:e9354. [PMID: 32850226 PMCID: PMC7444960 DOI: 10.7759/cureus.9354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The diagnosis of a right heart thrombus (RHTh) in transit associated with pulmonary embolism (PE) is an uncommon phenomenon with a high mortality rate. Timely recognition of RHTh with focused cardiac ultrasound (FOCUS) in cases of suspected PE is necessary for critical decision making in the emergency department (ED). We present a case of RHTh with submassive PE in which the patient underwent successful catheter-directed thrombolysis. This case report illustrates the significance of an emergency physician (EP) implementing FOCUS during the initial ED evaluation to rapidly diagnose RHTh in transit and initiate PE therapy without delay.
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Affiliation(s)
- Eric J Kalivoda
- Emergency Medicine, Hospital Corporation of America West Florida Graduate Medical Education Consortium/Brandon Regional Hospital, University of South Florida Morsani College of Medicine, Brandon, USA
| | - Kevin Rivera Rodriguez
- Emergency Medicine, Hospital Corporation of America West Florida Graduate Medical Education Consortium/Brandon Regional Hospital, University of South Florida Morsani College of Medicine, Brandon, USA
| | - Gabriel Cabrera
- Emergency Medicine, Hospital Corporation of America West Florida Graduate Medical Education Consortium/Brandon Regional Hospital, University of South Florida Morsani College of Medicine, Brandon, USA
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