Management of mobile right heart thrombi: a prospective series

Pierre-Justin, Gilbert; Piérard, Luc

doi:10.1016/j.ijcard.2003.10.071

Cited by 87 publications

(87 citation statements)

References 27 publications

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“…In another prospective series including 12 RHT patients, five patients were treated with heparin and three died (60% mortality). The other two patients improved after thrombolytic treatment (10). In our study, the mortality of heparin was similar to the previous studies (28%).…”

Section: Discussionsupporting

confidence: 92%

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Management of right heart thrombi associated with acute pulmonary embolism: a retrospective, single-center experience

Akıllı

Gül²,

Arıbaş³

et al. 2013

Anadolu Kardiyol Derg

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Objective: The mortality of right heart thrombi (RHT) associated with pulmonary embolism (PE) is increased about three to four times. The most devastating scenario is fragmentation of RHT and occurrence of recurrent PE. The reports regarding the management of RHT complicated with PE are very scarce in the current literature. Therefore, we report a single-center experience in this paper. Methods: From January 2006 to December 2011, data of all patients diagnosed with acute PE were analyzed retrospectively. Of the 312 acute PE cases confirmed with computed tomography, total 35 patients who were diagnosed with concomitant RHT (prevalence of 11%) by echocardiography were recruited. After excluding of six patients with metastatic malignancy a total 29 patients were accepted eligible for the analysis. In addition, catheter -induced thrombus (type B) were not included to the study. The difference between categorical variables was analyzed with Chi-square test and continuous variables were analyzed with Mann-Whitney U test. A p value of <0.05 was considered statistically significant. Results: Overall mortality was high (34%) in study population: among undergoing surgery-100%, therapy with thrombolytics -18%, and heparin -27%. Troponin levels were found significantly higher in died patients than that in survived patients (p=0.03). There was no significant difference regarding to clinical and echocardiographic characteristics of patients received heparin versus thrombolytic except for shock index (p=0.02). In addition, patients treated with heparin had increased duration of hospitalization compared to subjects treated with thrombolytic (median: 8 vs 3 days p<0.01). Conclusion: Despite of the low incidence of RHT, a mortal course is still an important problem during PE. The decision on treatment modality should be performed based on the hemodynamic parameters, laboratory findings, and bleeding risk of the patients. (Anadolu Kardiyol Derg 2013; 13: 528-33) Key words: Right heart thrombus, pulmonary embolism, thrombolysis, mortality Original Investigation Özgün Araşt›rma 528ÖZET Amaç: Pulmoner emboli (PE) ile ilişkili sağ kalp trombüslerinin mortalitesi 3-4 kat artmaktadır. En korkulan senaryo ise sağ kalp trombüslerinin parçalanması sonucunda rekürren pulmoner emboli gelişmesidir. Pulmoner embolilere eşlik eden sağ kalp trombüsü vakalarının tedavisi zordur ve bu konu ile ilgili literatürde yeterli veri bulunmamaktadır. Yöntemler: Ocak 2006 ila Aralık 2011 tarihleri arasında akut pulmoner emboli tanısı almış 312 hastanın verileri retrospektif olarak incelendi. Bilgisayarlı tomografi ile tanı almış 312 akut PE hastalarından ekokardiyografide sağ kalp trombüsü bulunan 35 hasta çalışmaya alındı. Metastatik malignansi bulunan 6 hasta çalışmadan dışlandı. Yirmi dokuz hasta değerlendirilme için uygun bulundu. Hastaların ekokardiyografik raporları da incelendi. Ayrıca katetere bağlı gelişen trombüs (tip B) vakaları da çalışmaya dahil edilmedi. Kategorik değişkenlerin karşılaştırılmasında Ki-kare ve non-parametrik sürekli de...

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Section: Discussionsupporting

confidence: 92%

“…Some studies reported similar mortality rate in all three treatment options (5,8). However, other studies documented low mortality rate in patients administered thrombolytic therapy (4,9,10). Surgical mortality is also high ranging from 20% to 50% even in the experienced centers (3,11).…”

Section: Introductionmentioning

confidence: 99%

Management of right heart thrombi associated with acute pulmonary embolism: a retrospective, single-center experience

Akıllı

Gül²,

Arıbaş³

et al. 2013

Anadolu Kardiyol Derg

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“…Obecność ruchomych skrzeplin w świetle prawej komory (RV) wiąże się ze złym rokowaniem i zwykle stanowi wskazanie do leczenia fibrynolitycznego [1]. W dotychczasowym piśmiennictwie brakuje jednak wyczerpujących danych dotyczących znaczenia klinicznego i odpowiedniego leczenia przyściennych skrzeplin zlokalizowanych w RV.…”

Section: Wstępunclassified

Right ventricular thrombus successfully dissolved with novel oral anticoagulant therapy

Wybraniec¹,

Mizia²,

Myszor³

et al. 2016

Kardiol Pol

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Samodzielny Publiczny Szpital Kliniczny nr 7, Śląski Uniwersytet Medyczny, Górnośląskie Centrum Medyczne im. prof. Leszka Gieca, Katowice S t r e s z c z e n i ePacjentka w wieku 71 lat bez objawów podmiotowych została przyjęta na Oddział Kardiologii z powodu zmiany w obrę-bie koniuszka prawej komory, przypadkowo stwierdzonej w tomografii komputerowej jamy brzusznej. W przezklatkowym badaniu echokardiograficznym zaobserwowano hipoechogeniczną, przyścienną strukturę o morfologii skrzepliny w świetle prawej komory (o wymiarach 32 mm × 16 mm) z obecnością hipokinezy przyległych segmentów ściany serca. W trakcie hospitalizacji wykluczono obecność choroby wieńcowej, zatorowości płucnej i systemową chorobę tkanki łącznej. Za pomocą rezonansu magnetycznego serca uwidoczniono hipointensywną skrzeplinę w koniuszku prawej komory, a kontrolna tomografia komputerowa serca potwierdziła stabilne wymiary i charakter zmiany. Na podstawie powyższego obrazu klinicznego wdrożono przewlekłe leczenie przeciwkrzepliwie nowymi doustnymi antykoagulantami (NOAC). Kontrolne badanie echokardiograficzne wykonane po 3 miesiącach od wypisania ze szpitala wykazało całkowitą regresję skrzepliny i normalizację odcinkowych zaburzeń kurczliwości prawej komory. Niniejszy opis przypadku dokumentuje możliwość zastosowania NOAC w celu leczenia incydentalnej, przyściennej skrzepliny w prawej komorze. Słowa kluczowe: nowe doustne antykoagulanty, NOAC, dabigatran, przyścienna skrzeplina, prawa komora A b s t r a c tA 71-year-old asymptomatic female was admitted to the department of cardiology on account of incidental finding of a tumour-like mass located in the apex of right ventricle, which was revealed during contrast-enhanced computed tomography of the abdominal cavity. Transthoracic echocardiography showed hypoechogenic right ventricular mass (32 mm × 16 mm), suggestive of thrombus with hypokinesia of the surrounding right ventricular wall. Coronary artery disease, connective tissue disease and pulmonary embolism were excluded. Cardiac magnetic resonance imaging indicated the presence of hypo-intense mural thrombus, while repeated computed tomography confirmed stable size and character of the lesion. The anticoagulation therapy with novel oral anticoagulant (NOAC) was instituted. Following three months of treatment, the echocardiographic assessment confirmed complete disappearance of thrombus and resolution of regional wall motion abnormalities. The present case indicates that NOAC can be utilised as effective agents in case of incidental right ventricular mural thrombus, unrelated to pulmonary embolism.

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“…Hareketli sağ ventrikül trombozu olanlarda trombolizin faydası tartışmalıdır. Kimi çalışmalarda fayda görülmüş 51,52 diğer çalışmalarda ise kısa dönem mortalitenin %20'nin üzerinde olduğu bildirilmiştir [53][54][55] .…”

Section: Trombolitik Tedaviunclassified

Pulmoner Embolinin Güncel Tedavisi

Tekin¹

2016

Arşiv Kaynak Tarama Dergisi

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Pulmonary embolism remains a major contributor to global disease burden. Risk-adapted treatment and follow-up contributes to a favorable outcome. The recommended definitive treatment for patients with high risk pulmonary embolism is thrombolysis. For patients with a contraindication to anticoagulation and thrombolytic therapy, surgical embolectomy and catheter-based therapies are options. In patients with intermediate-high risk pulmonary embolism, initiation of parenteral anticoagulation is recommended withour delay and thrombolytic therapy should only be given in case of hemodynamic worsening. Finally, direct oral anticoagulants have been shown to be as effective as and safer than the combination of low molecular weight heparin and vitamin K antagonist(s) in patients with low-to intermediate-risk pulmonary embolism. Key words: Pulmonary embolism, thrombolysis, anticoagulation. ÖZETPulmoner emboli küresel hastalık yüküne önemli bir katkıda bulunmaktadır. Risk uyumlu tedavi ve takip olumlu sonuçlar doğurmaktadır. Yüksek riskli pulmoner emboli hastasında tavsiye edilen kesin tedavi trombolizdir. Antikoagülasyon ve trombolitik tedaviye kontraendikasyonu olan hastalarda cerrahi embolektomi ve kateter aracılı tedaviler diğer şeçenektir. Orta-yüksek riskli pulmoner embolide parenteral antikoagülasyon gecikmeden başlanmalı ve hemodinamik kötüleşme olduğu takdirde trombolitik tedavi verilmelidir. Son olarak, düşük-orta riskli pulmoner embolide direkt oral antikoagülanların, düşük molekül ağırlıklı heparin ve K vitamini antagonisti kombinasyonu kadar etkin ve daha güvenli olduğu gösterilmiştir. Anahtar kelimeler: Pulmoner emboli, tromboliz, antikoagülasyon.

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Management of mobile right heart thrombi: a prospective series

Cited by 87 publications

References 27 publications

Management of right heart thrombi associated with acute pulmonary embolism: a retrospective, single-center experience

Management of right heart thrombi associated with acute pulmonary embolism: a retrospective, single-center experience

Right ventricular thrombus successfully dissolved with novel oral anticoagulant therapy

Pulmoner Embolinin Güncel Tedavisi

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