scholarly journals Case of a floating right atrial thrombus successfully treated with fibrinolysis

2019 ◽  
Vol 15 (1) ◽  
Author(s):  
Chloé Bernard ◽  
Olivier Bouchot ◽  
Marjolaine Georges ◽  
Marie Catherine Morgant
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Anticoagulation Therapy ◽  
Right Ventricular Dysfunction ◽  
Blood Gases ◽  
Good Alternative ◽  
Massive Pulmonary Embolism ◽  
Medical Emergency ◽  
Right Atrial

Mobile right atrial thrombi are at high risk of causing massive pulmonary embolism and are a medical emergency. This type of thrombus is identified in about 4-18% of pulmonary embolism cases. The presence of a free-floating embolic mass in right atrial or ventricle is often mortal: the death rate can reach 27%. Although surgery is commonly indicated, fibrinolysis is a therapeutic alternative. Here, a 58-year-old man presented to the emergency department for acute dyspnea associated with a painful right leg. Initial exams showed a shunt effect on blood gases with increased brain natriuretic peptide. Transthoracic echography (TTE) found a free-floating thrombus in the right atrium with signs of pulmonary hypertension and right ventricular dysfunction. Bilateral pulmonary embolism was confirmed by computed tomography angiography. Because there were signs of acute cor pulmonale and no contraindications, treatment with systemic fibrinolysis was decided. The treatment was delivered in intensive care unit and a cardiac surgical team was available. Subsequent clinical improvement was observed. TTE follow up at 12 hours revealed complete thrombus dissolution. There were no complications, in particular no hemorrhage. The patient was discharged after eleven days. At 6 months of follow-up, outcomes with oral anticoagulation therapy were satisfactory. Scintigraphy found good symmetrical perfusion of both lungs with stackable ventilation. TTE at 1 year showed preserved left and right ventricular function with no sign of pulmonary arterial hypertension and no thrombus recurrence. Systemic fibrinolysis appears to be a good alternative to surgery in this case.

scholarly journals Percutaneous thrombectomy and right ventricular mechanical circulatory support for pulmonary embolism in a COVID-19 patient: Case report, one-year update, and echocardiographic findings

2022 ◽  
Author(s):  
Gerald I Cohen ◽  
Theodore Schreiber ◽  
Hemindermeet Singh ◽  
Amir Kaki
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Massive Pulmonary Embolism ◽  
Circulatory Support ◽  
Medical Systems ◽  
One Year ◽  
Percutaneous Thrombectomy

Abstract Background We previously described percutaneous thrombectomy and right ventricular mechanical support of a COVID-19 patient with a massive pulmonary embolism. Here we present a detailed echocardiographic and clinical timeline with 1 year follow-up. Case Summary A 57-year-old female with COVID-19 went into shock from a massive pulmonary embolism. After percutaneous removal of a large thrombus burden (AngioVac system; AngioDynamics Inc, Latham, NY, USA), she became severely hypotensive, requiring CPR, and was resuscitated with an Impella RP device (Abiomed, Danvers, MA, USA). A pediatric TEE probe monitored the procedure because an adult probe would not pass (S7-3t—Philips Medical Systems, Andover, MA, USA). Post thrombectomy, surface imaging documented gradual resolution of right ventricular dysfunction, tricuspid regurgitation, and elevated pulmonary artery pressure. Her course was complicated by renal failure requiring temporary dialysis. She was discharged home on apixaban. Hypercoagulability work-up was negative. Two months later, vocal cord surgery was performed for persistent stridor. Esophagoscopy at that time was prevented by osteophyte obstruction. At 10 months, she received the Pfizer-BioNTech vaccine. At one year, the patient remains healthy on apixaban, and her echocardiogram is normal. Discussion This case illustrates the pivotal role of echocardiography in the diagnosis, percutaneous treatment, and near- and long-term follow-up and management of a patient with massive pulmonary embolism due to COVID-19 with documentation of complete recovery from severe right ventricular dysfunction and hemodynamic collapse. A pediatric TEE probe was a crucial alternative to the adult probe because of possible osteophyte obstruction.

Right Ventricular Dysfunction and Pulmonary Obstruction Index at Helical CT: Prediction of Clinical Outcome during 3-month Follow-up in Patients with Acute Pulmonary Embolism

Radiology ◽  
2005 ◽  
Vol 235 (3) ◽  
pp. 798-803 ◽  
Author(s):  
Rutger W. van der Meer ◽  
Peter M. T. Pattynama ◽  
Marco J. L. van Strijen ◽  
Annette A. van den Berg-Huijsmans ◽  
Ieneke J. C. Hartmann ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Outcome ◽  
Right Ventricular ◽  
Acute Pulmonary Embolism ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Helical Ct

scholarly journals Endovascular management of massive pulmonary embolism with clot fragmentation and suction

2013 ◽  
Vol 12 (1) ◽  
pp. 49-52
Author(s):  
Sergio Quilici Belczak ◽  
Igor Rafael Sincos ◽  
Ricardo Aun ◽  
Alex Lederman ◽  
Boulanger Mioto Neto ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Mechanical Thrombectomy ◽  
Imaging Study ◽  
Right Ventricular Dysfunction ◽  
Massive Pulmonary Embolism ◽  
Sudden Onset ◽  
Percutaneous Mechanical Thrombectomy ◽  
Limb Edema ◽  
To Receive

Massive pulmonary embolism with right ventricular dysfunction may be treated with thrombolysis, embolectomy, or percutaneous mechanical thrombectomy. This study describes our experience with two patients that had massive pulmonary embolism and were treated with percutaneous mechanical thrombectomy and reports on the mid-term results of this procedure. A 28-year-old man and a 70-year-old woman were diagnosed with deep venous thrombosis and massive pulmonary embolism. They first had lower limb edema followed by sudden onset of dyspnea. Their physical examination revealed edema, tachypnea, chest discomfort and jugular turgescence. Both needed to receive oxygen using a nasal cannula. Doppler ultrasound, echocardiography, and computed tomography angiography were used to establish the diagnoses. Patients underwent percutaneous mechanical thrombectomy using the Aspirex® system (Straub Medical), and their clinical condition and imaging study findings improved substantially. At mid-term follow-up, patient conditions were improving satisfactorily.

scholarly journals Pulmonary Embolism with Floating Right Atrial Thrombus Successfully Treated with Streptokinase

2017 ◽  
Vol 7 (1) ◽  
pp. 60-63
Author(s):  
Sahela Nasrin ◽  
Mohammad Salahuddin ◽  
Fathima Aaysha Cader ◽  
Md Jabed Iqbal ◽  
Tahera Nazrin ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Recombinant Tissue Plasminogen Activator ◽  
Right Atrial ◽  
Haemodynamic Instability ◽  
Atrial Thrombus ◽  
Pulmonary Angiogram ◽  
Right Atrial Thrombus

Massive Pulmonary Embolism (PE) is associated with significant mortality, especially if compounded by haemodynamic instability, right ventricular dysfunction and right atrial thrombus. Thrombolysis can be lifesaving in patients with major embolism and cardiogenic shock, and accelerates the resolution of thrombus. Only three fibrinolytic agents - namely streptokinase, urokinase, and recombinant tissue plasminogen activator (Alteplase) have been approved in the treatment of PE, with studies demonstrating similar safety profiles. We report the case of a 33 year old Bangladeshi female with a history of recent ankle fracture and immobilization, who presented with massive PE, leading to cardiac arrest. Upon rapid resuscitation, urgent echocardiogram revealed right ventricular dysfunction with floating right atrial thrombus, and she was successfully treated with 1.5 million IU of Streptokinase over 2 hours as per accelerated regimen recommended by the European Society of Cardiology (ESC) guidelines, resulting in successful resolution of the right heart thrombus, and significant clinical improvement. Subsequent CT Pulmonary Angiogram confirmed the diagnosis of PE, and she was anticoagulated to a PT/INR of 2.0 to 3.0.Anwer Khan Modern Medical College Journal Vol. 7, No. 1: Jan 2016, P 60-63

Biomarker-based strategy for screening right ventricular dysfunction in patients with non-massive pulmonary embolism

2006 ◽  
Vol 33 (2) ◽  
pp. 286-292 ◽  
Author(s):  
Damien Logeart ◽  
Lucien Lecuyer ◽  
Gabriel Thabut ◽  
Jean-Yves Tabet ◽  
Jean-Michel Tartière ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Massive Pulmonary Embolism

Clinical, historical and diagnostic findings associated with right ventricular dysfunction in patients with central and non-massive pulmonary embolism

2009 ◽  
Vol 5 (1) ◽  
pp. 53-59 ◽  
Author(s):  
Domenico Rendina ◽  
Silvana De Bonis ◽  
Giovanni Gallotta ◽  
Vincenzo Piedimonte ◽  
Giuseppe Mossetti ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Massive Pulmonary Embolism
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