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Chronic Thromboembolic Pulmonary Hypertension and Assessment of Right Ventricular Function in the Piglet
Published on: November 4, 2015
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Submassive pulmonary embolism with a right heart thrombus
Winnie Yan1, Ingrid Gunther2, Ali Hafiz2
1Critical Care Medicine, NYU Langone Health, New York, New York, USA winnie.yan@nyulangone.org.
BMJ Case Reports
|July 22, 2021
Summary
A patient with pulmonary embolism (PE) and a mobile right heart thrombus (FFRHT) experienced clot resolution with tissue plasminogen activator. This case highlights treatment considerations for FFRHT in acute PE.
Area of Science:
- Cardiology
- Vascular Medicine
- Thrombosis Research
Background:
- Pulmonary embolism (PE) is a significant cause of morbidity and mortality.
- Patent foramen ovale (PFO) can facilitate paradoxical embolism.
- Free-floating right heart thrombus (FFRHT) in the setting of acute PE presents unique management challenges.
Observation:
- A 49-year-old woman developed acute PE post-hip replacement.
- A large, mobile thrombus was identified in transit through a PFO from the right to the left atrium.
- The patient had symptoms of shortness of breath.
Findings:
- Intravenous tissue plasminogen activator (tPA) was administered for the PE and FFRHT.
- Successful resolution of the thrombus was achieved with tPA.
- Treatment resulted in a minor, hemodynamically insignificant bleeding complication at the surgical site.
Implications:
- This case underscores the potential efficacy of thrombolytic therapy for FFRHT in acute PE.
- Management decisions for FFRHT require careful consideration of stroke and mortality risks.
- Further discussion on treatment strategies for FFRHT in PE is warranted.
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