Surgical Embolectomy of a Floating Right Heart Thrombus and Acute Massive Pulmonary Embolism: Report of a Case

Abstract

Right heart thrombus represents a mobilized deep venous thrombosis that is lodged temporarily in the right atrium and ventricle, and is often referred to as "emboli in transit." Floating right heart thrombus is an uncommon but life-threatening condition, and usually coexists with an already massive pulmonary embolism. The presence of floating right heart thrombus appears to substantially increase the risk of mortality compared to the presence of pulmonary embolism alone. Floating right heart thrombus needs emergency treatment, but there is no clear consensus regarding optimal management, e. g.,thrombolytic therapy, anticoagulation therapy, or surgical removal. We present the case of an 80-year-old female with a floating right heart thrombus in conjunction with an acute massive pulmonary embolism, who presented in cardiogenic shock. We successfully carried out surgical embolectomy. The patient's postoperative course was uneventful, and she remained in good health without recurrence of pulmonary embolism. This success was based on rapid diagnosis by transthoracic echocardiography and computed tomography, prompt decision-making to proceed with surgical intervention and efficient postoperative care. In this case, surgical embolectomy was effective for a floating right heart thrombus with acute massive pulmonary embolism.