Surgical Treatment for Floating Right Heart Thrombus in High Risk Patients: A Case Report

Special Article – Clinical Case Reports

Austin J Cardiovasc Dis Atherosclerosis. 2016; 3(3): 1028.

Surgical Treatment for Floating Right Heart Thrombus in High Risk Patients: A Case Report

Redondo A*, Miguelena J, Martín M, Varela L, Fajardo E, López J, Muñoz R and Rodríguez-Roda J

Hospital Ramón y Cajal, Madrid, Spain

*Corresponding author: Redondo Ana, Department of Adult Cardiovascular Surgery, Hospital Ramón y Cajal, Madrid, Spain

Received: September 28, 2016; Accepted: October 28, 2016; Published: October 31, 2016


Background: Right heart floating thrombus or “embolus in transit” can be a very dangerous condition, usually associated to pulmonary thromboembolism. Even though many treatment options have been considered, nowadays, the recommended approach remains unclear. Surgical embolectomy has been used as an option, usually less preferred than thrombolysis or percutaneous approach, but it can be a safe and effective procedure in patients with high risk of embolization.

Methods: We present the case of a 70-year-old man with a diagnosed thrombus in transit, with high mobility and considerable embolization risk.

Results: Surgical embolectomy was performed, through median sternotomy and under cardiopulmonary bypass, removing a 20-cm long thrombus from the right atrium, in an uneventful procedure.

Conclusion: Surgical embolectomy, through median sternotomy and with extracorporeal circulation, is a safe approach for patients with high risk floating right atrium thrombus, and must be considered as an option for these patients. Further randomized studies must be carried out in order to determine which one is the best treatment for this entity.

Keywords: Right Heart Thrombus; Surgical Embolectomy


Right heart thrombus is a potentially threatening condition, with a described mortality up to 40% when it’s related to massive pulmonary embolism [1]. In some cases, these thrombi are “floating” inside the right atrium, with a significant increase of the embolization risk and, therefore, require an emergent therapeutic decision. So far, this question has been discussed in many occasions, considering both options, thrombolysis and surgical embolectomy, equally valid for these patients considering their clinical context, but the evidence available concerning this matter is still weak [2].

Case Presentation

We present the case of a 70-year-old man, without any cardiovascular risk factor, with a recent history of a long period of immobility due to a cranial trauma.

He presented with an episode of pain and swelling of the right lower limb, being diagnosed of an iliofemoral venous thrombosis by echocardiography. Therefore, he was treated with low-molecularweight heparin. After 24 hours, he presented with sudden shortness of breath, chest pain and loss of consciousness. A computed tomographic pulmonary angiography revealed a massive bilateral acute pulmonary thromboembolism (Figure 1).