PMID- 29850139
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220317
IS  - 2072-1439 (Print)
IS  - 2077-6624 (Electronic)
IS  - 2072-1439 (Linking)
VI  - 10
IP  - 4
DP  - 2018 Apr
TI  - Early surgical treatment in patients with pulmonary embolism and 
      thrombus-in-transit.
PG  - 2338-2345
LID - 10.21037/jtd.2018.04.41 [doi]
AB  - BACKGROUND: Floating right heart thrombi (RHT) are in transit from the legs to 
      the pulmonary arteries and thus are a severe form of venous thromboembolism 
      (VTE), with a high early mortality rate without treatment. There is a lack of 
      evidence-based recommendations for its management. The objective of this study is 
      to describe our experience in the surgical management of thrombus-in-transit and 
      pulmonary embolism (PE) in a tertiary hospital. METHODS: We recruited four 
      patients with thrombus-in-transit and PE treated with early surgical embolectomy 
      and anticoagulation. Epidemiologic, laboratory, imaging and clinical data of the 
      thromboembolic episode and the subsequent course were collected. RESULTS: The 
      sample included 3 males and 1 female, with a mean age of 49.7. The most frequent 
      initial symptoms were dyspnea, syncope, chest pain and signs of deep vein 
      thrombosis (DVT). Transthoracic echocardiogram (TTE) found the 
      thrombus-in-transit in all the cases. The inicial treatment was unfractionated 
      heparin (UFH) and urgent right atriectomy and manual removal of the thrombi. 
      Three patients needed perioperative infusion of vasopressor drugs. All patients 
      had right heart dysfunction at the time of diagnosis. The mean scoring in the 
      Pulmonary Embolism Severity Index (PESI) was 90. All patients survived after 30 
      days of follow-up. CONCLUSIONS: Early surgical embolectomy of thrombus-in-transit 
      is an effective option of management in selected patients, although the current 
      evidence to support this approach is not definitive.
FAU - Galeano-Valle, Francisco
AU  - Galeano-Valle F
AD  - Venous Thromboembolism Unit, Hospital General Universitario Gregorio Maranon, 
      Madrid, Spain.
FAU - Demelo-Rodriguez, Pablo
AU  - Demelo-Rodriguez P
AD  - Venous Thromboembolism Unit, Hospital General Universitario Gregorio Maranon, 
      Madrid, Spain.
FAU - Garcia-Fernandez-Bravo, Irene
AU  - Garcia-Fernandez-Bravo I
AD  - Venous Thromboembolism Unit, Hospital General Universitario Gregorio Maranon, 
      Madrid, Spain.
FAU - Rodriguez-Abella, Hugo
AU  - Rodriguez-Abella H
AD  - Department of Cardiovascular Surgery, Hospital General Universitario Gregorio 
      Maranon, Madrid, Spain.
FAU - Irabien-Ortiz, Angela
AU  - Irabien-Ortiz A
AD  - Department of Cardiovascular Surgery, Hospital General Universitario Gregorio 
      Maranon, Madrid, Spain.
FAU - Fortuny-Ribas, Ramon
AU  - Fortuny-Ribas R
AD  - Department of Cardiovascular Surgery, Hospital General Universitario Gregorio 
      Maranon, Madrid, Spain.
FAU - Del Toro-Cervera, Jorge
AU  - Del Toro-Cervera J
AD  - Venous Thromboembolism Unit, Hospital General Universitario Gregorio Maranon, 
      Madrid, Spain.
LA  - eng
PT  - Journal Article
PL  - China
TA  - J Thorac Dis
JT  - Journal of thoracic disease
JID - 101533916
PMC - PMC5949483
OTO - NOTNLM
OT  - Pulmonary embolism (PE)
OT  - right heart thrombi (RHT)
OT  - right heart thrombus in transit (right heart TT)
OT  - surgical embolectomy
COIS- Conflicts of Interest: The authors have no conflicts of interest to declare.
EDAT- 2018/06/01 06:00
MHDA- 2018/06/01 06:01
PMCR- 2018/04/01
CRDT- 2018/06/01 06:00
PHST- 2018/06/01 06:00 [entrez]
PHST- 2018/06/01 06:00 [pubmed]
PHST- 2018/06/01 06:01 [medline]
PHST- 2018/04/01 00:00 [pmc-release]
AID - jtd-10-04-2338 [pii]
AID - 10.21037/jtd.2018.04.41 [doi]
PST - ppublish
SO  - J Thorac Dis. 2018 Apr;10(4):2338-2345. doi: 10.21037/jtd.2018.04.41.