Review of echocardiographically diagnosed right heart entrapment of pulmonary emboli-in-transit with emphasis on management

Farfel, Zvi; Shechter, Michael; Vered, Zvi; Rath, Shmuel; Goor, Daniel A.; Gafni, Joseph

doi:10.1016/0002-8703(87)90026-3

Cited by 162 publications

(110 citation statements)

References 43 publications

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“…A large registry and a small RCT support that the mortality of patients with RHTE and PE, treated with intravenous heparin, was no different from that of untreated patients. 34,42 Treatment options for hemodynamically significant PE, associated with RV dilation or dysfunction, include surgery, thrombolysis, and catheter-directed embolectomy and fragmentation. Catheter removal mandates careful consideration of the potential for clot dislodgement and distal embolization.…”

Section: Prevention Of Cvc Associated Thrombosismentioning

confidence: 99%

“…Consequently, variable mortality estimates (7% to 29.2%) associated with surgical embolectomy can be found in the literature. 1,34,42 In a non randomized study, Gulba et al 44 assigned 37 patients with clinically suspected massive PE and shock to undergo either embolectomy or thrombolysis. The authors found survival rates of 77 and 67% favouring embolectomy, but acknowledged that a strong argument could be made for thrombolysis, given the limitations imposed by surgical availability.…”

Section: Surgerymentioning

confidence: 99%

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A critical review of thromboembolic complications associated with central venous catheters

Burns

McLaren

2008

Can J Anesth/J Can Anesth

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Purpose: Central venous catheters (CVC) are commonly used in critical care. While thrombosis is a well-recognized and frequent complication associated with their use, CVC-related thromboembolic complications, including pulmonary embolism (PE) and right heart thromboembolism (RHTE), occur less frequently and often evade diagnosis. Little information exists to guide clinicians in the diagnosis and management of CVC-related thromboembolic complications. Source:We critically review and synthesize the literature highlighting the incidence of CVC-related thrombosis. We highlight the risk for developing thromboembolic complications and provide approaches to diagnosing and managing RHTE. Principle findings:The incidence of CVC-related thrombosis varies depending on patient, site, instrument, and infusaterelated factors. Central venous catheters-related thrombosis represents an important source of morbidity and mortality for affected patients. Pulmonary embolism occurs in approximately 15% of patients with CVC-related upper extremity deep venous thrombosis (UEDVT). More frequent use of transesophageal echocardiography, in patients with suspected and confirmed PE, has resulted in increased detection of RHTE. While it is recognized that the occurrence of RHTE, in association with PE, increases mortality, the optimal strategy for their management has not been established in a clinical trial. Conclusion:Central venous catheter-related thrombosis occurs frequently and represents an important source of morbidity and mortality for affected patients. Our review supports that surgery and thrombolysis have both been demonstrated to enhance survival in patients with RHTE and PE. However, important patient, clot, and institutional considerations mandate that treatment for patients with RHTE and PE be individualized.

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Section: Prevention Of Cvc Associated Thrombosismentioning

confidence: 99%

Section: Surgerymentioning

confidence: 99%

A critical review of thromboembolic complications associated with central venous catheters

Burns

McLaren

2008

Can J Anesth/J Can Anesth

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“…The treatment of choice is heart surgery with cardiopulmonary bypass:, ' I In a retrospective study of 48 patients with mobile right atrial thrombi, the thrombus-related mortality in relation to treatment was 64% in the anticoagulation group versus 27% in the surgery group.ll In a retrospective study by Farfel et al, the mortality in patients undergoing surgery ( 15%) was lower than that with conservative treatment (48%). 4 Although selection of surgical patients was biased in both studies, these studies show that anticoagulation is insufficient in these patients. Intravenous thrombolysis may be an alternative to open heart surgery and is extensively used in this indi~ation,l*-'~ although no clinical trial has demonstrated the superiority of this therapeutic measure compared with surgery.…”

Section: Discussionmentioning

confidence: 97%

Thrombolysis of mobile right atrial thrombi following severe pulmonary embolism

Cracowski

Tremel

Baguet

et al. 1999

Clinical Cardiology

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Summary:Thrombolysis may favorably affect the clinical outcome of mobile right atrial thrombus following puimonary embolism (PE). We report the case of three patients with mobile right atrial thrombus following PE, in whom fibrinolysis was performed. Atrial mass disappeared on the control echocardiogram, but control ventilation perfusion scan showed new perfusion defects in all patients. Thrombolysis seems successful for the treatment of patients with mobile right atrial thrombus following PE; however, recurrent PE may be induced by fibrinolysis. This may affect the benefit of such therapy and should be taken into account when using this therapeutic treatment.

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“…Point of care ultrasound, as in our case, can lead to a more prompt diagnosis. On these imaging modalities, a right heart thrombus in transit has been described as a highly mobile, coiled, or serpiginous mass, usually in the right atrium with prolapse into the ventricle (3,4).…”

Section: Discussionmentioning

confidence: 99%