A 28-year-old policeman presented with left lower limb deep vein thrombus, pulmonary embolism and a highly mobile right atrial clot. Thrombolytic therapy with IV Tenecteplase was administered. Within a few minutes after the Tenecteplase bolus, the patient's condition worsened dramatically with severe hypotension and hypoxemia. Immediate bedside transthoracic echocardiogram revealed that the mobile right atrium clot had disappeared completely presumably having migrated to the pulmonary circulation thus worsening the clinical condition. With intensive supportive measures the patient's condition was stabilized and he made a complete recovery. Prior to discharge, the echocardiogram revealed normal right ventricular function and a CT pulmonary angiogram performed after 2 months revealed near complete resolution of pulmonary thrombi. Thrombolytic therapy for right heart thrombus with pulmonary embolism can be a reasonable first line therapy but may be associated with hemodynamic worsening due to clot migration.
Isolated tricuspid valve disease is rare. We report the case of a 65-year-old female patient who presented with right heart failure. Initial echocardiographic evaluation revealed a giant right atrium (RA) with severe tricuspid inflow obstruction with regurgitation. A comprehensive two- and three-dimensional echocardiographic evaluation revealed a dysplastic tricuspid valve resulting in the inflow obstruction and regurgitation. Rheumatic and carcinoid etiologies were ruled out by relevant tests. It is very rare for dysplastic tricuspid valve to present in late adulthood. The classic echocardiographic findings are discussed followed by a brief review of the literature.
Bilateral renal artery stenting Renovascular hypertension a b s t r a c tThromboembolism is a well-known complication of mitral stenosis especially when it is associated with atrial fibrillation. Renal artery embolism is uncommon and can remain undetected especially when it involves one kidney. We report the case of a 42-year-old female patient of severe mitral stenosis, atrial fibrillation and left atrial appendage clot who had systemic hypertension. After successful percutaneous mitral commissurotomy, a renal angiogram was done which revealed a right renal artery which was occluded from the ostium and a subtotally occluded left renal artery. Bilateral renal artery stenting was done in the same sitting. Her blood pressure normalized and it remains so after two followup visits without any anti-hypertensive medications. The possible etiologies for the occluded renal arteries are discussed followed by a brief review of the literature.Copyright ª 2012, Indian College of Cardiology. All rights reserved.Thromboembolism is a well-known complication of mitral stenosis especially when it is associated with atrial fibrillation. But renal embolization generally remains an undiagnosed clinical condition because renal function disorders are only noticed when patients have bilaterally affected arteries, previous chronic renal insufficiency or involvement of a solitary functioning kidney. 1 We report the case of a 42-year-old female patient presenting with a 6-month history of shortness of breath of functional NYHA class III. On clinical examination, patient had an irregular pulse with a rate of 102/min, and an increased blood pressure of 190/90 mmHg in right upper limb, 188/90 mmHg in left upper limb and 194/88 mmHg in right lower limb in supine position. Cardiovascular system examination revealed irregular first and second heart sounds, and a long apical mid-diastolic murmur with clinical evidence of pulmonary hypertension. There was no renal artery bruit. 2D Transthoracic Echocardiography revealed severe mitral stenosis with concentric left ventricular (LV) hypertrophy and normal LV function (Fig. 1 Panels A and B). Transesophageal Echocardiography revealed a clot measuring 0.9 Â 1.7 cm which was restricted to left atrial appendage ( Fig. 1 Panels C and D). Percutaneous mitral commissurotomy (PTMC) was done with Inoue technique using 26 cc balloon with two serial dilations with volumes of 20 and 21 cc. PTMC was successful with significant hemodynamic improvement. In view of systemic hypertension, a renal angiogram was performed with a pigtail catheter in the aorta. Angiogram showed total occlusion of right renal artery from ostium and a 95% ostio-proximal narrowing of * Corresponding author. Post-Graduate Student,
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.