自由漂浮的右心血栓合并肺栓塞1例

Slavica Majdevac, Ranko Zdravkovic, Andrej Preveden, Ilija Bjeljac, Mihaela Preveden, Aleksandar Redzek
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摘要

介绍。右心血栓并不常见,通常在静脉血栓栓塞患者中通过超声心动图检测到。心房或心室壁上的血栓预后良好;然而,自由漂浮?蛇一样?血栓通常伴随着大量不稳定的肺栓塞和高死亡率。病例报告。一名43岁的男性患者在上周就诊于心脏病专家,他抱怨自己快速疲劳和呼吸短促。超声心动图检查证实右心血栓和肺栓塞。检查后,病例被提交给心脏小组,他们决定进行手术。在常规的急诊手术术前准备后,患者在气管内麻醉下经胸骨正中切开手术。结论。右心血栓有可能栓塞肺循环和潜在的循环衰竭的危险。有相当大的差异,表面上温和的临床表现和惊人的超声心动图发现一个巨大的自由浮动血栓。尽管对于最佳治疗策略缺乏标准化和精确的建议,手术方法似乎是急诊大型自由漂浮血栓的最佳选择。
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Free-floating right heart thrombus with pulmonary embolism - a case report
Introduction. Right heart thrombus is uncommon and it is usually detected by echocardiography in patients with venous thromboembolism. Thrombi attached to the atrial or ventricular wall have a good prognosis; however, free-floating ?snake-like? thrombi are usually associated with massive, unstable pulmonary embolism and high mortality. Case Report. A 43-year-old male patient visited a cardiologist complaining about rapid fatigue and shortness of breath with minimal effort in the last week. An echocardiographic examination confirmed a right heart thrombus and a pulmonary embolism. After the examination, the case was presented to the Heart Team, which made a decision to perform a surgery. After the usual preoperative preparation for emergency surgery, the patient underwent surgery under general endotracheal anesthesia via median sternotomy. Conclusion. The right heart thrombus is associated with risks of possible embolization to the pulmonary circulation and potential circulatory collapse. There was a considerable discrepancy between the apparently mild clinical presentation and the alarming echocardiographic finding of a huge free-floating thrombus. Despite the lack of standardized and precise recommendations for the optimal therapeutic strategy, surgical approach seems to be the best option in emergency cases with large free-floating thrombi.
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