Free-floating thrombi in the right heart -: Diagnosis, management, and prognostic indexes in 38 consecutive patients
Free-floating thrombi in the right heart -: Diagnosis, management, and prognostic indexes in 38 consecutive patients
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DOI：
10.1161/01.cir.99.21.2779
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发表时间：
1999-06-01
期刊：
影响因子：
37.8
通讯作者：
Théry, C
中科院分区：
文献类型：
--
作者：
Chartier, L;Béra, J;Théry, C
背景-漂浮右心血栓（FRHTS）是一种罕见的现象，遇到几乎完全在怀疑或证实肺栓塞和经胸超声心动图诊断的患者，他们的管理仍然存在争议。方法和结果-我们报告了一系列的38个连续的患者在过去的12年中遇到。32例患者为NYHA IV级，20例为心源性休克。超声心动图通常显示肺心病的体征：右心室超负荷（91.7%的人群），反常室间隔运动（75%）和肺动脉高压（86.1%）。血栓通常呈蠕虫状（36/38例患者）。4例从左心房穿过未闭卵圆孔。除1例外，所有患者均证实存在肺栓塞。无论选择何种治疗方案，死亡率都很高（38例患者中的17例）：手术（17例中的8例）、溶栓（9例中的2例）、肝素（8例中的5例）或介入性经皮技术（4例中的2例）。院内死亡率与心脏骤停的发生显著相关。相反，出院后的结果通常是好的，因为21例患者中有18例在47.2个月后仍然存活（范围，1至70个月）。结论严重肺栓塞是我们系列FRHTS的规则（死亡率，44.7%），治疗的选择对死亡率没有影响。急诊手术通常是提倡的。然而，溶栓是一种更快，更容易获得的治疗方法，似乎有希望作为唯一的治疗方法或作为手术的桥梁。对于有手术或溶解疗法禁忌症的患者，可建议使用介入技术。
Background-Floating right heart thrombi (FRHTS) are a rare phenomenon, encountered almost exclusively in patients with suspected or proven pulmonary embolism and diagnosed by transthoracic echocardiography, Their management remains controversial.Methods and Results-We report on a series of 38 consecutive patients encountered over the past 12 years. Thirty-two patients were in NYHA class IV, 20 in cardiogenic shock. Echocardiography usually demonstrated signs of cor pulmonale: right ventricular overload (91.7% of the population), paradoxical interventricular septal motion (75%), and pulmonary hypertension (86.1%). The thrombus was typically wormlike (36 of 38 patients). It extended from the left atrium through a patent foramen ovale in 4 patients. Pulmonary embolism was confirmed in all but 1. Mortality was high (17 of 38 patients) irrespective of the therapeutic option chosen: surgery (8 of 17), thrombolytics (2 of 9), heparin (5 of 8), or interventional percutaneous techniques (2 of 4), The in-hospital mortality rate was significantly linked with the occurrence of cardiac arrest. Conversely, the outcome after discharge was usually good, because 18 of 21 patients were still alive 47.2 months later (range, 1 to 70 months).Conclusions-Severe pulmonary embolism was the rule in our series of FRHTS (mortality rate, 44.7%), The choice of therapy had no effect on mortality. Emergency surgery is usually advocated. However, thrombolysis is a faster, readily available treatment and seems promising either as the only treatment or as a bridge to surgery. In patients with contraindications to surgery or lytic therapy, interventional techniques may be proposed.