FFRHT is an extreme emergency. Delays in treatment are strongly associated with mortality: up to 20% of patients die within the first day of admission. Older age, presence of shock or severe hypoxemia, and conservative management using only heparin portend poorer prognosis. Trreatment options must include either thrombolysis or surgical embolectomy with exploration of the right heart and pulmonary arteries under full cardiopulmonary bypass. Outcomes between these two approaches are comparable, although in the hemodynamically unstable patient, the latter approach may be preferred.,, Perioperative hemodynamic instability, as in this patient, is common, and patients should be treated in an intensive care unit with close attention to inotropic support and right ventricular function. Rarely, a right ventricular assist device may be used to bypass the failed right ventricle while awaiting dissolution or recanalization of the thrombotic burden.