title: Management of right heart thrombi associated with acute pulmonary embolism: a retrospective, single-center experience.
abstract: OBJECTIVE
  The mortality of right heart thrombi (RHT) associated with pulmonary embolism (PE) is increased about three to four times. The most devastating scenario is fragmentation of RHT and occurrence of recurrent PE. The reports regarding the management of RHT complicated with PE are very scarce in the current literature. Therefore, we report a single-center experience in this paper.
  
  
  METHODS
  From January 2006 to December 2011, data of all patients diagnosed with acute PE were analyzed retrospectively. Of the 312 acute PE cases confirmed with computed tomography, total 35 patients who were diagnosed with concomitant RHT (prevalence of 11%) by echocardiography were recruited. After excluding of six patients with metastatic malignancy a total 29 patients were accepted eligible for the analysis. In addition, catheter -induced thrombus (type B) were not included to the study. The difference between categorical variables was analyzed with Chi-square test and continuous variables were analyzed with Mann-Whitney U test. A p value of <0.05 was considered statistically significant.
  
  
  RESULTS
  Overall mortality was high (34%) in study population: among undergoing surgery-100%, therapy with thrombolytics -18%, and heparin -27%. Troponin levels were found significantly higher in died patients than that in survived patients (p=0.03). There was no significant difference regarding to clinical and echocardiographic characteristics of patients received heparin versus thrombolytic except for shock index (p=0.02). In addition, patients treated with heparin had increased duration of hospitalization compared to subjects treated with thrombolytic (median: 8 vs 3 days p<0.01).
  
  
  CONCLUSIONS
  Despite of the low incidence of RHT, a mortal course is still an important problem during PE. The decision on treatment modality should be performed based on the hemodynamic parameters, laboratory findings, and bleeding risk of the patients.
authors.affiliation: Department of Cardiology, Meram Faculty of Medicine, Konya University, Konya-Turkey. elvin_salamov@yahoo.com.
authors.forename: Hakan
authors.initials: H
authors.lastname: Akıllı
authors.forename: Enes Elvin
authors.initials: EE
authors.lastname: Gül
authors.forename: Alpay
authors.initials: A
authors.lastname: Arıbaş
authors.forename: Kurtuluş
authors.initials: K
authors.lastname: Özdemir
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kayrak
authors.forename: Halil Ibrahim
authors.initials: HI
authors.lastname: Erdoğan
mesh_terms: D004452:Echocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality; D014057:Tomography, X-Ray Computed; D014421:Turkey / Q000453:epidemiology
chemical_list: D005343:Fibrinolytic Agents