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. 2020 Sep 17;7(12):001918.
doi: 10.12890/2020_001918. eCollection 2020.

Treatment of Mobile Right Heart Thrombi

Xenofon M Sakellariou  1 , Andreas Efstathopoulos  1 , Konstantinos V Stamatis  1 , Dimitrios N Nikas  1 , Theofilos M Kolettis  1
Affiliations

Treatment of Mobile Right Heart Thrombi

Xenofon M Sakellariou et al. Eur J Case Rep Intern Med. .

Abstract

Right heart thrombi are detected in approximately 4% of patients with pulmonary embolism. The associated mortality is high, but the optimal strategy remains controversial. We report a case of a large mobile right heart thrombus, complicated by embolism of the right pulmonary artery, which was successfully treated with half-dose alteplase. We briefly review the literature and discuss the therapeutic options, focusing on the advantages of thrombolysis.

Learning points: Mobile right heart thrombi require rapid therapeutic choices between surgical thrombectomy and thrombolysis.Half-dose alteplase may be effective, even in the presence of an extensive thrombus burden.

Keywords: Mobile right heart thrombi; half-dose alteplase; pulmonary embolism.

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Conflict of interest statement

Conflicts of Interests: The Authors declare that there are no competing interests.

Figures

Figure 1
Figure 1
CT scan showing obstruction of the right pulmonary artery (arrow, top panel), with restoration of patency after treatment (bottom panel)
Figure 2
Figure 2
Transthoracic echocardiogram (four-chamber view) showing a large thrombus across the tricuspid valve (left panel), resolving after treatment (right panel)
Video 1
Video 1
Transthoracic echocardiogram (four-chamber view) showing a large mobile thrombus moving across the tricuspid valve. Watch the video: https://youtu.be/4j8C1VYmnPo
See this image and copyright information in PMC

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