Two Cases of Acute Pulmonary Embolisms with Floating Thrombi in the Right Heart

(Department of Cardiovascular Surgery, National Chiba Hospital, Chiba, Japan)

Toshiaki Ohto Masahisa Masuda Yoshihisa Tsukagoshi
Emergency operation was performed for 2 cases of acute pulmonary embolism which showed floating thrombi in the right atrium and right ventricle. Case 1 was a 48-year-old man without any contributory past history. Case 2 was a 65-year-old woman with a history of old myocardial infarction and chronic left heart failure with only 19% of the left ventricular ejection fraction. Although their preoperative hemodynamics and respiratory conditions were stable, ultrasound examination revealed floating thrombi in the right heart. Sudden death could have occurred if the occlusions had migrated to the pulmonary artery. Thus, emergency operation was selected instead of thrombolysis. During operation, the blood pressure suddenly decreased before the establishment of the cardiopulmonary bypass in both cases. This may have been the result of sudden additional pulmonary embolism, because no floating thrombi were noted in the right atrium or right ventricle at operation. After operation, case 1 recovered quickly although case 2 was discharged only after 6 months. It is highly possible that the presence of right heart thrombi change the hemodynamics rapidly. Therefore, emergency operation is necessary even when the hemodynamics and respiratory condition are stable. Thrombectomy is recommended even to patients such as case 2 in a serious condition, because this surgical procedure under cardiopulmonary bypass has been proven to be very safe.
@Jpn. J. Cardiovasc. Surg. 33: 266-269 (2004)