Free-floating right heart thrombus with pulmonary embolism - a case report

Abstract

Introduction. Right heart thrombus is uncommon and it is usually detected by echocardiography in patients with venous thromboembolism. Thrombi attached to the atrial or ventricular wall have a good prognosis; however, free-floating ?snake-like? thrombi are usually associated with massive, unstable pulmonary embolism and high mortality. Case Report. A 43-year-old male patient visited a cardiologist complaining about rapid fatigue and shortness of breath with minimal effort in the last week. An echocardiographic examination confirmed a right heart thrombus and a pulmonary embolism. After the examination, the case was presented to the Heart Team, which made a decision to perform a surgery. After the usual preoperative preparation for emergency surgery, the patient underwent surgery under general endotracheal anesthesia via median sternotomy. Conclusion. The right heart thrombus is associated with risks of possible embolization to the pulmonary circulation and potential circulatory collapse. There was a considerable discrepancy between the apparently mild clinical presentation and the alarming echocardiographic finding of a huge free-floating thrombus. Despite the lack of standardized and precise recommendations for the optimal therapeutic strategy, surgical approach seems to be the best option in emergency cases with large free-floating thrombi.