Abstract
We report a case of multiple mobile intra-cardiac thrombi accompanying recurrent pulmonary embolism that has been successfully treated by fibrinolytic therapy. Control transesophageal echocardiographic examination showed that prolonged thrombolytic treatment completely removed the thrombi.Surgical removal of emboli has been validated but cannot be proposed to all patients since it is a high-risk intervention. Fibrinolysis is generally efficient but exposes the patient to risk of migration of the intra-cavity thrombus, with occasionally deleterious evolution. Systemic thrombolytic therapy is usually recommended if (a) it is not contraindicated and (b) the thrombi are demonstrated in more than one cardiac chamber, entailing a higher risk of surgical intervention. However, the infusion rate and duration of thrombolytic therapy are important determinants of successful and uncomplicated lysis. Low dose and long infusion time should be chosen to avoid fragmentation of the thrombus and related complications.
Highlights
TmlFerifogtabunaistrlereisueo1mcphhoaggeenailcemchaosscainrdriiogghrtaapthryiudme,mriognhsttvraetnintrgicfuloluamtinagn, d Transesophageal echocardiography demonstrating floating, mobile echogenic mass in right atrium, right ventriculum and left atrium
Cardiac-sourced thromboembolism can be predicted on the basis of echocardiographic, clinical, electrocardiographic and laboratory assessments, such as the presence of spontaneous echocontrast, large hypokinetic cardiac chambers, mitral stenosis, history of thromboemboli, atrial fibrillation and increased coagulation markers
Intravenous fibrinolytic treatment for multiple intracardiac mobile thrombi should be given in low doses and for long times to avoid subsequent migration of the intra-cardiac thrombus
Summary
Cardiac thrombus may be a complication of primary cardiac, hematological and rheumatological disease [1]. Protein C-deficient patients usually develop venous thrombotic complications between the ages of 15 and 40 years with a high incidence of deep venous thrombosis and pulmonary embolism [2]. In the event of mobile multiple intra-cardiac thrombi, surgery might not be a good choice for their complete removal. In these conditions, thrombolytic therapy might be preferable [8]. Intravenous fibrinolytic treatment for multiple intracardiac mobile thrombi should be given in low doses and for long times to avoid subsequent migration of the intra-cardiac thrombus. We have reported a case of recurrent pulmonary embolism with mobile multiple intra-cardiac thrombi, in which the disappearance of the thrombi following successful thrombolytic therapy was documented by TEE examination
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