CardioVascular and Interventional Radiology

, Volume 20, Issue 2, pp 142–145

Right atrial thrombi: Percutaneous mechanical thrombectomy

  • Jean-Paul Beregi
  • Valérie Aumégeat
  • Christophe Loubeyre
  • Jean-Michel Coullet
  • Philippe Asseman
  • Caroline Debacker-Steckelorom
  • Jean-Jacques Bauchart
  • Peng Cheng Liu
  • Claude Théry
Case Reports

Abstract

The current therapeutic options for right atrial thrombi—surgical embolectomy and thrombolysis— are associated with high mortality and such patients often have contraindications to these therapeutic options. the purpose of this study was to evaluate the feasibility of endovascular right atrial embolectomy. Two patients with contraindications to thrombolysis and surgery were treated by a femoral approach. A catheter was placed in the right atrium, under fluoroscopic control, and a basket device was used to trap the thrombus. The location and extent of the thrombus was established before the procedure by transesophageal echocardiography (TEE) and the procedure was performed with TEE and fluoroscopy. Thrombi were withdrawn in the basket into the inferior vena cava (IVC) and a filter was inserted by a jugular approach and positioned in the IVC, just above the thrombi. The basket was removed leaving the thrombus below the filter. One patient died immediately after the procedure. In conclusion, endovascular extraction of right atrial thrombi may represent a potential therapeutic alternative, particularly in patients with contraindications to thrombolysis and surgery.

Key words

Atrial thrombi Pulmonary emboli Endovascular treatment Thrombolytic therapy 

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References

  1. 1.
    Chakko S, Richard F (1987) Right sided cardiac thrombi and pulmonary embolism. Am J Cardiol 59: 195–196PubMedCrossRefGoogle Scholar
  2. 2.
    Taupin JM, Chapoutot L, Metz D, Ouzan J, Pollet E, Elaerts J, Bajolet A (1988) Thrombus flottant de l’OD dans l’embolie pulmonaire aiguë: Aspects cliniques, echocardiographiques et incidences thérapeutiques. Ann Cardiol Angeiol (Paris) 37: 243–247Google Scholar
  3. 3.
    Starkey IR, De Bono D (1982) Echocardiographic identification of right sided cardiac intracavitary thromboembolus in massive pulmonary embolism. Circulation 66: 1322–1325PubMedGoogle Scholar
  4. 4.
    Malloy PC, Gore JM, Rippe JM, Paraskos JA, Benotti JR, Ockene IS, Alpert JS, Dalen JC (1984) Transient atrial thrombus resulting in pulmonary embolism detected by two dimensional echocardiography. Am Heart J 108: 1047–1049PubMedCrossRefGoogle Scholar
  5. 5.
    Armstrong WF, Feigenbaum H, Dillon JC (1985) Echocardiographic detection of right atrial thromboembolism. Chest 87: 801–806PubMedCrossRefGoogle Scholar
  6. 6.
    Farfel Z, Schechter M, Vered Z, Rath S, Goor D, Gafni J (1987) Review of echocardiographically diagnosed right heart entrapment of pulmonary emboli in transit with emphasis on management. Am Heart J 187: 171–178CrossRefGoogle Scholar
  7. 7.
    Kinney EL, Wright RJ (1989) Efficacy of treatment of patients with echocardiographically detected right side heart thrombi: A meta-analysis. Am Heart J 118: 569–573PubMedCrossRefGoogle Scholar
  8. 8.
    Chapoutot L, Metz D, Canivet E, Maillier B, Torossian F, Pommier JL, Nazeyrollas P, Sal R, Baehrel B, Elaerts J (1993) Thrombus mobile au coeur et embolie pulmonaire: Problèmes diagnostique et thérapeutique. Arch Mal Coeur 86: 1039–1045PubMedGoogle Scholar
  9. 9.
    Boulay F, Neimann JL, Danchin N, Godenir JP, Abellan MC, Amrein D (1986) Aspects cliniques, echo-cardiographiques et évolutifs des thromboses de l’oreillette droite. Arch Mal Coeur 79: 282–289PubMedGoogle Scholar
  10. 10.
    Kronik G (1990) From the European Working Group on Echocardiography. The European cooperative study on the clinical significance of the right heart thrombi. Eur Heart J 10: 1046–1059Google Scholar
  11. 11.
    Thery C, Bauchard JJ, Lesenne M, Asseman P, Flajollet JG, Legghe R, Marache P (1992) Predictive factors of effectiveness of streptokinase in deep venous thrombosis. Am J Cardiol 69: 117–122PubMedCrossRefGoogle Scholar
  12. 12.
    Goldsmith JC, Lollar P, Hoak JC (1990) Massive fatal pulmonary emboli with fibrinolytic therapy. Circulation 64: 1068–1081Google Scholar
  13. 13.
    Fournier P, Pacouret G, Charbonnier B, Marchal C, Rioux P (1992) Thrombus des cavités cardiaques droites, intérêt de la thrombolyse dans le traitement du thrombi mobile. Arch Mal Coeur 85: 877–882PubMedGoogle Scholar
  14. 14.
    Goldhaber SZ, Nagel JS, Theard M, Levine JD, Sutton MGS (1988) Treatment of right atrial thrombus with urokinase. Am Heart J 115: 894–897PubMedCrossRefGoogle Scholar
  15. 15.
    Hunter JA, Sessions R, Buenger R (1970) Experimental balloon obstruction of the inferior vena cava. Ann Surg 171: 315–320PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag New York Inc 1997

Authors and Affiliations

  • Jean-Paul Beregi
    • 1
  • Valérie Aumégeat
    • 1
  • Christophe Loubeyre
    • 2
  • Jean-Michel Coullet
    • 1
  • Philippe Asseman
    • 2
  • Caroline Debacker-Steckelorom
    • 1
  • Jean-Jacques Bauchart
    • 2
  • Peng Cheng Liu
    • 1
  • Claude Théry
    • 2
  1. 1.Service de Radiologie Vasculaire, Hôpital CardiologiqueCHRU de LilleLille CédexFrance
  2. 2.Service des Soins Intensifs, Hôpital CardiologiqueCHRU de LilleLille CédexFrance

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