doctor functional diagnostics Institut of Cardiology Chisinau, Chisinau, Moldova
Background: Prompt diagnosis of pulmonary embolism (PE) remains challenging, which often results in a delayed or inappropriate treatment of this life-threatening condition. Mobile thrombus in the right cardiac chambers is a neglected cause of PE. It poses an immediate risk to life and is associated with an unfavorable outcome and high mortality.
Aims: The aim of this study was to analyze echocardiographic findings and to assess therapeutic management in 110 patients with proven PE, in 7(6,3%) cases with floating RA thrombus diagnosed with transthoracic and transesophageal echocardiography in the first 24 hours after hospitalization.
Methods: Echocardiography displayed a mobile ovoid, polycyclic or worm-like right atrial mass, always associated with signs of PH. This study is part of national research project 20.80009.8007.28.
Results: All patients with atrial thrombosis showed signs of high PH, with maximum systolic pressure in PA 64,2±3,42mmHg and the average 37,65± 2,41mmHG. The echocardiographic results were revealed a more dilation of RA (with area 27,53 ± 3,13cm2), VD (39,5± 3,11cm), PA trunk (28,1± 2,41cm), ETT confirmed MCConnell sign in 4 patients, with the relationship of end-diastolic diameter VD/VS>1; more obvious dilation of the IVC diameter (23.11±2.11cm); increase in the tricuspidal regurgitation, which averaged 3.8±1.77m/sec. All these patients had significantly lower index TAPSE (15.54± 4.21mm) and the tissue index S ́m RV (8.6± 1.21cm/sec), the signs that confirmed the presence of systolic dysfunction of RV. Also, in this group was observed a significant reduction in the relation TAPSE/Pulmonary Artery Systolic Pressure, the average being 0.29±1.11 (0.18-0.37).We observed two cases of floating migratory thrombus from the RA cavity into the LA through the patent oval foramen, with the signs of mechanical obstruction of the mitral valve orifice.
Conclusion(s): Our data suggest that echocardiographic examination is necessary in all suspected PE and has to be done quickly for emergency treatment in patients with floating RA thrombus.
