Surgical thrombectomy for right heart thrombus with acute aortic dissection.
An 81-year-old female complaining of severe back pain was admitted to hospital and diagnosed with acute type A aortic dissection with a thrombosed false lumen. Aggressive antihypertensive therapy was selected. On day 8, computed tomography showed pulmonary artery thrombus, and transthoracic echocardiography showed a 76×70 mm worm-like floating right heart thrombus. Thrombolytic therapy is reported to be the optimal treatment for patients with pulmonary embolism and floating right heart thrombus, but is contraindicated in acute aortic dissection. The patient underwent surgical thrombectomy, which revealed thrombus entrapped in the Chiari network. An inferior vena cava filter was placed. The patient recovered uneventfully and was discharged home after initiation of warfarin therapy.
Division of Intensive and Cardiovascular Care Unit, Nippon Medical School Hospital, Nippon Medical School, Tokyo, Japan.
Aya
A
Fukuizumi
Koichi
K
Akutsu
Yukichi
Y
Tokita
Takeshi
T
Yamamoto
Wataru
W
Shimizu
Kyoichi
K
Mizuno
Keiji
K
Tanaka
D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications* / Q000175:diagnosis; D001014:Aortic Aneurysm / Q000150:complications* / Q000175:diagnosis; D001027:Aortography / Q000379:methods; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis; D004452:Echocardiography; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000209:etiology*; D017131:Thrombectomy; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016306:Vena Cava Filters