[Right biventricular and atrial thrombi: echocardiographic diagnosis and peroperative verification]

An exceptional case of triple intracardiac thrombosis (right atrium and right and left ventricles) is reported. The 21-year old male patient without significant previous history was admitted in a state of acute circulatory failure, with blood pressure 80/45 mmHg and a left ventricular end-diastolic diameter of 74 mm. Echocardiography showed dilated cardiomyopathy with low output pattern and demonstrated the presence of three large intracavitary thrombi: the first one was attached to the lateral wall of the right ventricle and occupied most of the apex; the second one, with multiple lobes, was located in the left ventricle, and the third thrombus was appended to the roof of the right atrium. The severity of the patient's condition made it necessary to implant an artificial heart (Jarvik's heart), and this was followed, 15 days later, by cardiac transplantation. Pathological examination of the explanted heart confirmed the presence of the three thrombi and of a cardiomyopathy of undetermined origin. This is first case of this type published so far.