MOBILE RIGHT HEART THROMBI IN PULMONARY-E MBOLISM

Systematic transthoracic echocardiography in all cases of pulmonary em bolism may demonstrate right heart thrombi. The results of this monoce ntric series of 28 consecutive cases observed between 1987 and 1996 we re analysed. Twenty-four patients were in NYHA Class IV: thirteen were in cardiogenic shock. Echocardiographic signs of acute cor pulmonale were usually observed : 96.3 % of patients had right ventricular dilat ation, 85.2 % paradoxical interventricular septal motion, 88,9 % pulmo nary hypertension. The thrombus was typical serpentine (27/28 cases) a rising from the lower limb veins. Passage into the left heart chambers through a patent foramen ovale was observed in 3 cases. Pulmonary emb oslism was confirmed in all cases. This is an extreme therapeutic emer gency and 13 patients (46.4 %) died despite treatment : surgery (7/16) , thrombolysis (2/5), heparin (3/4) or interventional radiology (1/3). After the acute phase, the prognosis was generally good, as demonstra ted by the 100 % survival rate at 28.6 +/- 25 months. This study confi rms the gravity of mobile right heart thrombi in pulmonary embolism. T he diagnosis is echocardiographic. No significant difference in mortal ity was observed between the different therapeutic approaches used in this series. The echocardiographic finding of these thrombi is a tradi tional indication for emergency surgical embolectomy. Thrombolysis is rapid and readily available and seems to provide promising results alo ne or before surgery. In patients with contraindications to thrombolys is, interventional radiology or simple heparin therapy may be proposed .