title: Therapeutic approach in patients with a floating thrombus in the right heart.
abstract: BACKGROUND
  The occurrence of a floating thrombus in the right heart, although rare, is a life-threatening condition requiring a specific approach. In most cases, these thrombi are a result of embolization from deep venous thrombosis, and have lodged temporarily in the right heart. The management of this condition is variable, depending on whether or not there is a thrombus entrapped within a foramen ovale (FO).
  
  
  OBJECTIVE
  To present the management of 2 patients with a free-floating thrombus in the right heart, and a third patient with an entrapped thrombus in the FO.
  
  
  METHODS
  Two patients with a free-floating thrombus in the right atrium who were treated with thrombolytic therapy had an immediate excellent outcome. The patient with a thrombus entrapped within the FO was scheduled for surgical removal of the thrombus due to an unacceptable risk of systemic embolization if treated with thrombolytic and anticoagulant therapy. Unfortunately, he developed an ischemic stroke on the fifth day of presentation, just a few hours before the scheduled surgery, despite meticulous monitoring of continuous heparin infusion with activated partial thromboplastin time.
  
  
  CONCLUSIONS
  Thrombolytic therapy is recommended in patients with a free-floating thrombus in the right heart. However, in patients with a thrombus entrapped within an FO, delaying surgical removal of the thrombus may be deleterious due to unpredictable systemic embolization.
authors.affiliation: Clinic of Emergency Medicine, Military Medical Academy, Belgrade, Serbia.
authors.forename: Boris
authors.initials: B
authors.lastname: Dzudovic
authors.forename: Slobodan
authors.initials: S
authors.lastname: Obradovic
authors.forename: Sinisa
authors.initials: S
authors.lastname: Rusovic
authors.forename: Branko
authors.initials: B
authors.lastname: Gligic
authors.forename: Saso
authors.initials: S
authors.lastname: Rafajlovski
authors.forename: Radoslav
authors.initials: R
authors.lastname: Romanovic
authors.forename: Nenad
authors.initials: N
authors.lastname: Ratkovic
authors.forename: Dragan
authors.initials: D
authors.lastname: Dincic
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D054085:Foramen Ovale; D006325:Heart Atria; D006331:Heart Diseases / Q000175:diagnosis / Q000188:drug therapy*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000209:etiology; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000175:diagnosis / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006493:Heparin; D010959:Tissue Plasminogen Activator