Right heart transiting thrombi caused by endovenous sclerotherapy: the treatment is not consensual

Bedside transthoracic echocardiogram (TTE) showed an acute pulmonary heart disease with dilation of the right ventricle (RV), associated with a large floating thrombus in the right atrium (online supplementary video 1 and supplementary video 2 ). Independently of the aetiology, patients with PE asso...

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Bibliographic Details
Published in:BMJ case reports 2017-11, Vol.2017, p.bcr-2017-223032
Main Authors: Laghlam, Driss, Hamadouche, Sara, Dautry, Raphael, Spagnoli, Vincent
Format: Article
Language:English
Subjects:
Anticoagulants
Blood clots
Cardiovascular disease
Case reports
Compression therapy
Embolisms
Family medical history
Health risk assessment
Heart
Images In
Medical imaging
Mortality
Patients
Pulmonary arteries
Sclerotherapy
Systematic review
Thromboembolism
Thrombosis
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Summary:Bedside transthoracic echocardiogram (TTE) showed an acute pulmonary heart disease with dilation of the right ventricle (RV), associated with a large floating thrombus in the right atrium (online supplementary video 1 and supplementary video 2 ). Independently of the aetiology, patients with PE associated with RV dysfunction and myocardial injury (intermediate-risk to high-risk pulmonary embolism), thrombolytic therapy should be considered if clinical signs of haemodynamic decompensation appeared. 3-5 Among patients who appear haemodynamically stable, the presence of a right heart thrombi is associated with high early mortality, evaluating between 20% and 30% in patients treated by heparin independently of further thrombolysis administration. 6 7 Because of low incidence and conflicting results, there are no clear recommendations for the management of this subset of patients. 5 Surgical embolectomy, interventional approach, thrombolysis therapy or heparin alone can be considered. N Engl J Med 2014; 370: 1402-11. doi:10.1056/NEJMoa1302097 5 Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2017-223032