Affiliation:
1. Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica + University of Novi Sad, Faculty of Medicine, Novi Sad
2. Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica
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.
Publisher
National Library of Serbia