[Thrombi of the right heart. Value of thrombolytic therapy in mobile thrombi].
Seven patients with mobile right heart thrombi, 4 floating and 3 pediculated, were recensed between 1985 and 1990. Two patients were admitted for congestive cardiac failure (Group I) and 5 patients for pulmonary embolism (Group II). Both patients in Group I were treated with heparin without complications. In one case, the size of the thrombus decreased in 10 days whereas, in the second case, it disappeared within 8 days. In Group II, the first patient underwent successful thrombectomy. The other four patients were given thrombolytic therapy (UK = 2, rt-PA = 2) associated with appropriate doses of heparin. In the two patients given UK (3M units the first day followed by 1.2 M units per day for 4 days) the thrombus disappeared in the first 48 hours of treatment. One patient had a recurrent pulmonary embolism after 2 hours' treatment; both patients had a fall in haemoglobin of 3 cg/ml at the second day. The second patient died at the 5th day. In the two patients treated by rt-PA (100 mg/7 hours) the thrombus disappeared within 4 hours of starting therapy. One patient had a probable recurrent pulmonary embolism. Both patients had a fall in haemoglobin of 3 cg/ml at the 2nd day of treatment. Right heart thrombi are rare (168 cases in the literature of which 111 were mobile). The prognosis seems to be related to echocardiographic appearances: mortality of mural thrombi is about 4% compared with 50% in mobile thrombi. Very mobile "worm-like" masses are therapeutic emergencies because of the risk of embolism (about 68%).(ABSTRACT TRUNCATED AT 250 WORDS)
Fournier
P
P
Service de cardiologie D, CHU Trousseau, Tours.
Pacouret
G
G
Charbonnier
B
B
Marchal
C
C
Rioux
P
P
D000328:Adult; D000368:Aged; D004359:Drug Therapy, Combination; D015150:Echocardiography, Doppler; D004630:Emergencies; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006333:Heart Failure / Q000209:etiology; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010960:Plasminogen Activators / Q000627:therapeutic use*; D011655:Pulmonary Embolism / Q000209:etiology; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*
D006493:Heparin; D010960:Plasminogen Activators
Thrombus des cavités cardiaques droites. Intérêt de la thrombolyse dans le traitement des thrombi mobiles.