The presence of a mobile clot in the right heart (RH), distinguishes a particular severe form of pulmonary embolism (PE). The outcome of these clots during or after thrombolytic treatment(TT) is poorly known. We described the outcome of RH mobile clots in patients hospitalized in our cardiology department for PE.
A transthoracic echocardiography was performed on entry in all patients hospitalized for PE. When a RH clot, was seen echocardiography was repeated twice a day for 48 hours, then once a day.
From Jan 1998 to May 2002, 343 patients were hospitalized in our cardiology department for PE. 18 patients (5.2%) presented a mobile clot in the RH. In all cases, PE was severe: mean right to left end diastolic diameters = 0.82; mean systolic pulmonary pressure = 68mmHg. All thrombi were located in the right atrium, except one, which was trapped in a patent foramen ovale. All thrombi were mobile. Mean length was 4.2 cm. The treatment chosen was TT (tPA, 2 hours infusion) in 16 cases (88%); heparin alone in one, surgical removal for the thrombus trapped in the foramen ovale. All patients were alive at day 30. In all cases treated with TT, the clot disappeared. This happened in 8 cases (50%) just after the end of TT, in 4 cases (25%) between the 4th and the 12th hour after TT, and in the remaining 4 cases (25%) between the 12th and the 24th hour. In the only patient treated with heparin alone, the clot was still present on day 5.
A mobile clot can be seen in the RH in about 5% of patients presenting PE. In our series, TT gave excellent results. Clots disappeared immediately during or after TT in 50% of cases and within 24h in 100% of cases. It is noteworthy that the course of the disease was favorable even when the clots did not disappear immediately.
E. Ferrari, None.