PMID- 35722436
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220716
IS  - 2305-5839 (Print)
IS  - 2305-5847 (Electronic)
IS  - 2305-5839 (Linking)
VI  - 10
IP  - 10
DP  - 2022 May
TI  - The removal of floating right heart thrombi and pulmonary embolus using AngioJet 
      device and venoarterial extracorporeal membrane oxygenation: a case report.
PG  - 612
LID - 10.21037/atm-22-1542 [doi]
LID - 612
AB  - BACKGROUND: Floating right heart thrombi (FRHTS), known as thrombi in transit, 
      are usually located in the atrium or ventricle. Generally, it occurs in patients 
      with pulmonary embolism (PE) and dyspnea, chest pain, syncope and palpitations 
      are the most common symptoms on presentation. The mortality of patients with 
      FRHTS is higher than that of those without FRHTS. Current treatment includes 
      anticoagulation, systemic thrombolysis, catheter directed interventions, and 
      surgical embolectomy. However, there is no consensus on the optimal management 
      options. CASE DESCRIPTION: Herein, we report the case of a patient who presented 
      with hypotension and tachycardia accompanied by an asymptomatic right leg deep 
      vein thrombosis, right atrial thrombus, and pulmonary embolus. He had a history 
      of radical resection of colon cancer 1 month prior. And he had developed chest 
      tightness accompanied by stabbing pain in the chest area 1 day ago. He 
      experienced an episode of syncope 8.5 hours ago. So he was referred to the local 
      hospital. After the pulmonary computed tomography angiography (CTA) scan, he was 
      diagnosed with pulmonary embolus and administrated with 5,000 u low molecular 
      weight heparin. Then he was transferred to our hospital. On arrival in the 
      emergency department, the bedside transthoracic echocardiography (TTE) revealed 
      there was an enlarged right atrium and right ventricle, with a floating right 
      atrial mass prolapsing through the tricuspid valve during diastole. The patient 
      accepted anticoagulation treatment, but refused to undergo thrombolysis or 
      surgical embolectomy. Eventually, the right heart thrombi (RiHT) floated to the 
      left main branch of pulmonary artery. It was successfully treated by using 
      AngioJet device and venoarterial extracorporeal membrane oxygenation (VA-ECMO). 
      Our case provides clinical evidence supporting the feasibility and efficacy of 
      AngioJet device and VA-ECMO in the treatment of the RiHT and PE. CONCLUSIONS: 
      Patients with PE combined with RiHT have higher mortality than those without 
      RiHT, VA-ECMO could be used to maintain the circulation, and the AngioJet device 
      could be used as an alternative treatment for patients who are reluctant to 
      receive thrombolysis or surgical embolectomy.
CI  - 2022 Annals of Translational Medicine. All rights reserved.
FAU - Chen, Guang
AU  - Chen G
AD  - Department of Vascular Surgery, Taizhou Hospital of Zhejiang Province, Zhejiang 
      University, Linhai, China.
FAU - Zhang, Xiaolong
AU  - Zhang X
AD  - Department of Vascular Surgery, Taizhou Hospital of Zhejiang Province, Zhejiang 
      University, Linhai, China.
FAU - Wang, Qin
AU  - Wang Q
AD  - Medical Research Center, Taizhou Hospital of Zhejiang Province, Zhejiang 
      University, Linhai, China.
FAU - Qin, Jie
AU  - Qin J
AD  - Department of Emergency Intensive Care Unit, Taizhou Hospital of Zhejiang 
      Province, Zhejiang University, Linhai, China.
FAU - Xu, You-Zu
AU  - Xu YZ
AD  - Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province, 
      Zhejiang University, Linhai, China.
FAU - Li, Xiang
AU  - Li X
AD  - Department of Vascular Surgery, Taizhou Hospital of Zhejiang Province, Zhejiang 
      University, Linhai, China.
FAU - Li, Fei
AU  - Li F
AD  - Department of Vascular Surgery, Taizhou Hospital of Zhejiang Province, Zhejiang 
      University, Linhai, China.
FAU - Wang, Xiang
AU  - Wang X
AD  - Department of Vascular Surgery, Taizhou Hospital of Zhejiang Province, Zhejiang 
      University, Linhai, China.
FAU - Hu, Bin
AU  - Hu B
AD  - Department of Vascular Surgery, Taizhou Hospital of Zhejiang Province, Zhejiang 
      University, Linhai, China.
FAU - Chu, Haiwei
AU  - Chu H
AD  - Department of Vascular Surgery, Taizhou Hospital of Zhejiang Province, Zhejiang 
      University, Linhai, China.
FAU - Zheng, Dexing
AU  - Zheng D
AD  - Department of Vascular Surgery, Taizhou Hospital of Zhejiang Province, Zhejiang 
      University, Linhai, China.
FAU - Zhang, Jiecheng
AU  - Zhang J
AD  - Department of Vascular Surgery, Taizhou Hospital of Zhejiang Province, Zhejiang 
      University, Linhai, China.
FAU - Zhao, Wenjun
AU  - Zhao W
AD  - Department of Vascular Surgery, Taizhou Hospital of Zhejiang Province, Zhejiang 
      University, Linhai, China.
FAU - Ma, Lingping
AU  - Ma L
AD  - Department of Operation Room, Taizhou Hospital of Zhejiang Province, Zhejiang 
      University, Linhai, China.
LA  - eng
PT  - Case Reports
PL  - China
TA  - Ann Transl Med
JT  - Annals of translational medicine
JID - 101617978
PMC - PMC9201192
OTO - NOTNLM
OT  - Floating right heart thrombi (FRHTS)
OT  - case report
OT  - pulmonary embolism (PE)
OT  - transthoracic echocardiography (TTE)
OT  - venoarterial extracorporeal membrane oxygenation (VA-ECMO)
COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure 
      form (available at 
      https://atm.amegroups.com/article/view/10.21037/atm-22-1542/coif). All authors 
      report that this study was sponsored by Taizhou Hospital of Zhejiang Province, 
      Zhejiang University, and the study was financially supported by the Taizhou 
      Municipal Bureau of Science, Technology (Nos. 1701KY01 and 1901KY09) and the 
      Zhejiang Province Public Welfare Application Technology Research Plan (No. 
      LGF20H020007). AngioJet device (Boston Scientific, Marlborough, MA, USA) is 
      involved in the management of the case, but the authors have no intersection of 
      interest with the device company. The authors have no other conflicts of interest 
      to declare.
EDAT- 2022/06/21 06:00
MHDA- 2022/06/21 06:01
PMCR- 2022/05/01
CRDT- 2022/06/20 04:07
PHST- 2022/02/21 00:00 [received]
PHST- 2022/05/10 00:00 [accepted]
PHST- 2022/06/20 04:07 [entrez]
PHST- 2022/06/21 06:00 [pubmed]
PHST- 2022/06/21 06:01 [medline]
PHST- 2022/05/01 00:00 [pmc-release]
AID - atm-10-10-612 [pii]
AID - 10.21037/atm-22-1542 [doi]
PST - ppublish
SO  - Ann Transl Med. 2022 May;10(10):612. doi: 10.21037/atm-22-1542.