title: Clinical and echocardiographic diagnosis, follow up and management of right-sided cardiac thrombi.
abstract: BACKGROUND
  Right-sided cardiac masses are infrequent and have varied clinical presentation. The present study describes the clinical features, echocardiographic findings and management of 19 patients presenting with right-sided cardiac thrombi in a tertiary care center in north India.
  
  
  METHODS
  This is a retrospective, single center observational study of consecutive patients over the period January 2003-2008 admitted in our emergency intensive care unit (EICU). We identified 38 patients with right-sided cardiac masses admitted to EICU diagnosed by transthoracic echocardiography of which 19 patients had right-sided thrombus. The echocardiographic findings were reviewed by two cardiologists in all patients. Treatment was not standardized and choice of therapy was based on judgment of attending physician.
  
  
  RESULTS
  The mean age of patients with cardiac thrombus was 36.6 ± 11.8 years. Right atrial (n = 17) and right ventricle (n = 2) thrombi were associated with deep vein thrombosis (DVT) in 7 (36.8%) and pulmonary embolism in 3 (15%) patients. 13 (68.4%) patients appeared to have in situ mural thrombus. 12 patients were managed with oral anticoagulants, 3 patients underwent surgery and 4 patients were thrombolysed. All the survivors had a mean follow-up of 40 ± 6 months (range--18-50 months).
  
  
  CONCLUSIONS
  Prompt echocardiographic examination in an appropriate clinical setting facilitates faster diagnosis and management of patients with right-sided cardiac thrombi. High incidence of in situ mural thrombus and varied comorbidities predisposing to right-sided cardiac thrombi besides DVT and pulmonary embolism need to be recognized. Oral anticoagulation and thrombolysis appear to be the mainstay of treatment with surgery limited for selected patients.
authors.affiliation: Department of Cardiology, Dayanand Medical College & Hospital, Unit Hero DMC Heart Institute, Ludhiana, Punjab, India. Electronic address: shibbachhabra@yahoo.com.
authors.forename: Bishav
authors.initials: B
authors.lastname: Mohan
authors.forename: Shibba Takkar
authors.initials: ST
authors.lastname: Chhabra
authors.forename: Amarpal
authors.initials: A
authors.lastname: Gulati
authors.forename: Chander
authors.initials: C
authors.lastname: Mohan Mittal
authors.forename: Gaurav
authors.initials: G
authors.lastname: Mohan
authors.forename: Rohit
authors.initials: R
authors.lastname: Tandon
authors.forename: S
authors.initials: S
authors.lastname: Kumbkarni
authors.forename: Naved
authors.initials: N
authors.lastname: Aslam
authors.forename: Naresh K
authors.initials: NK
authors.lastname: Sood
authors.forename: Gurpreet Singh
authors.initials: GS
authors.lastname: Wander
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods; D002423:Cause of Death; D015331:Cohort Studies; D003131:Combined Modality Therapy; D015150:Echocardiography, Doppler / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D006801:Humans; D007194:India; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D017131:Thrombectomy / Q000379:methods; D015912:Thrombolytic Therapy / Q000379:methods; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D016896:Treatment Outcome
keywords: ASD; ATT; BMV; CA; CABG; CCP; CTEPH; Cardiac; DVT; EICU; ELISA; Echocardiography; HIV; IV; IVC; LA; LV; MI; MVR; Oral anticoagulation; PA; PAH; PASP; PFO; RA; RV; RVOT; Right atrium; STK; TEE; Thrombolysis; Thrombus; VQ; antitubercular treatment; atrial septal defect; balloon mitral valvotomy; carcinoma; chronic constrictive pericarditis; chronic thromboembolic pulmonary hypertension; coronary artery bypass grafting; deep vein thrombosis; emergency intensive care unit; enzyme linked immunosorbent assay; human immunodeficiency virus; inferior vena cava; intravenous; left atrial; left ventricle; mitral valve replacement; myocardial infarction; patent foramen ovale; pulmonary arterial hypertension; pulmonary artery; pulmonary artery systolic pressure; recombinant tissue plasminogen activator; right atrial; right ventricle; right ventricle outflow tract; rtPA; streptokinase; trans-esophageal echocardiography; ventilation perfusion