Selwanos Peter Philip Shaker, Ahmed Ahmed Osman, El Bakry Karim Mohamed, Elsharkawy Ahmed Nazmy, Mohamed Omar Alaaeldin, Hosny Hatem, Samaan Amir Anwar Shaker
Department of Cardiology, Aswan Heart Centre, Magdi Yacoub Foundation, 72 Kasr Elhagar street, Elsail Elegedeed, Aswan, PO 81511, Egypt.
Department of Cardiology, Cairo University Hospital, Cairo, Egypt.
Egypt Heart J. 2020 Nov 11;72(1):79. doi: 10.1186/s43044-020-00112-x.
Floating right heart thrombi (RHT) represent an underdiagnosed, potentially hazardous, and to some extent rare phenomenon in patients presenting with acute pulmonary embolism (APE). Emergent treatment is usually required for such a condition.
A 19-year-old young lady presented with progressive shortness of breath, marked renal impairment, thrombocytopenia, and a highly oscillating huge right atrial mass. After she was admitted to the intensive care unit, she arrested in asystole and was resuscitated, and her electrocardiogram (ECG) showed evidence of acute anterior myocardial infarction. Urgent cardiac surgery to remove the right atrial mass was proposed by the heart team as the best option of management. Surgery was emergently performed with extra-corporeal membrane oxygenator (ECMO) as a support. Following surgery, mechanical support and vasopressors were successfully weaned and the patient achieved a good recovery.
A pulmonary embolism response team (PERT) approach should always be considered where a multidisciplinary team involving a cardiologist, radiologist, cardio-thoracic surgeon, radiologist, and intensivist shall determine the management strategy for a challenging presentation of a massive pulmonary embolism or floating right heart thrombi causing the hemodynamically unstable clinical condition.
在急性肺栓塞（APE）患者中，漂浮性右心血栓（RHT）是一种诊断不足、具有潜在危险性且在一定程度上较为罕见的现象。通常需要对此类情况进行紧急治疗。
一名19岁年轻女性出现进行性呼吸急促、明显肾功能损害、血小板减少以及一个高度摆动的巨大右心房肿块。她被收入重症监护病房后，出现心搏停止并经复苏成功，其心电图（ECG）显示有急性前壁心肌梗死的证据。心脏团队建议紧急进行心脏手术以切除右心房肿块，作为最佳治疗选择。在体外膜肺氧合（ECMO）支持下紧急进行了手术。术后，成功撤掉了机械支持和血管升压药，患者恢复良好。
对于出现大量肺栓塞或漂浮性右心血栓导致血流动力学不稳定临床状况的具有挑战性的病例，应始终考虑采用肺栓塞反应团队（PERT）方法，由包括心脏病专家、放射科医生、心胸外科医生、放射科医生和重症监护医生在内的多学科团队来确定治疗策略。
