06-54 - WHAT IS THE PREVALENCE OF FREE-FLOATING THROMBI IN THE RIGHT HEART COMPLICATING ACUTE PULMONARY EMBOLISM2 - 09/04/08
Imad Abi Nasr,
Nicolas Mansencal,
Roland N’Guetta,
Jean-Christian Farcot,
Thierry Joseph,
Pascal Lacombe,
Olivier Dubourg
Voir les affiliationsBackground: Free-floating thrombi in the right heart is considered as exceptional in acute pulmonary embolism (PE). Studies evaluating such complications are rare. The aim of this study was to estimate the prevalence of free-floating thrombi in the right heart in a population of patients presenting with acute PE.
Methods: We studied 195 consecutive patients with confirmed PE (by CT-scan or lung scintigraphy) and all these patients underwent transthoracic echocardiography. We systematically assessed: 1) right to left ventricular end-diastolic area ratio using 2D echo in apical 4-chamber view and a right ventricular dilation was defined as a ratio > 0.6; 2) systolic pulmonary arterial pressure (SPAP) using CW Doppler and 3) the presence of free-floating thrombi in the right heart using 2D echo and we separated thrombi prolapsing into the tricuspid valve from those less mobile in the right atrium.
Results: Mean age was 66 ± 18 yo (range: 16-95), 76 men and 119 women. Using transthoracic echocardiography, 81 patients (42%) presented with right ventricular dilation, SPAP was measurable in 138 patients (71%) and mean SPAP was 42 ± 12 mmHg. Eleven patients had free-floating thrombi in the right heart. The prevalence of free-floating thrombi in the right heart in our population was 5.6%. The characteristics of free-floating thrombi in the right heart were as follows: the thrombus was serpentine, very mobile and prolapsing into the tricuspid valve in 9 patients and was less mobile and spherical in 2 patients; all patients had also right ventricular dilation and mean SPAP was 50 ± 5 mmHg (p = 0.03).
Conclusion: Our study suggests that the prevalence of free-floating thrombi in the right heart in acute PE is 5.6%. This complication is not so unusual in acute PE and should be systematically assessed using transthoracic echocardiography.
© 2007 Elsevier Masson SAS. Tous droits réservés.
Vol 100 - N° 12
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