Anaesthetic considerations in a patient with right heart thrombi‐in‐transit

• Published in: Acta anaesthesiologica Scandinavica Vol. 49; no. 1; pp. 117 - 121
• Main Authors: Rastogi, S., Abraham, M., Geelani, M. A., Trehan, V., Nagesh, A.
• Format: Journal Article
• Language: English
• Published: Oxford, UK; Malden, USA Munksgaard International Publishers 01.01.2005; Blackwell
• Subjects: Adult; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anticoagulants - therapeutic use; Biological and medical sciences; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Coronary Thrombosis - complications; Coronary Thrombosis - drug therapy; Coronary Thrombosis - surgery; Echocardiography; Embolectomy; Female; Heparin, Low-Molecular-Weight - therapeutic use; Humans; intracardiac thrombi‐in‐transit; intra‐operative hypotension; Medical sciences; Postoperative Complications - diagnostic imaging; Postoperative Complications - drug therapy; Postoperative Complications - therapy; pulmonary embolism; Pulmonary Embolism - complications; Pulmonary Embolism - drug therapy; Pulmonary Embolism - surgery; transthoracic echocardiography; Vena Cava Filters; Vascular disease; Pulmonary embolism; Human; intra-operative hypotension; Echocardiography; Respiratory disease; trans- thoracic echocardiography; Right heart; Cardiovascular disease; Anesthesia; intracardiac thrombi-in-transit; Embolectomy
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/j.1399-6576.2005.00513.x

This is a case report of a patient with underlying pulmonary thromboembolism who was diagnosed as having a large, mobile right heart thrombi while undergoing treatment with low‐molecular weight heparin. She underwent emergency embolectomy with exploration of the right heart under a cardiopulmonary bypass (CPB). Soon after induction of anaesthesia, the patient had an episode of severe hypotension, which responded to inotropes. Large, serpiginous thrombi were found in the right atrium extending into the right ventricle and pulmonary arteries, which were evacuated. She was weaned off CPB on inotropic support and was extubated uneventfully on the 4th POD. Postoperatively, she was started on anticoagulant therapy and also underwent placement of a Greenfield inferior vena caval (IVC) filter to prevent further thromboembolic episodes.