Right Heart Transvalvular Embolus with High Risk Pulmonary Embolism in a Recently Hospitalized Patient: A Case Report of a Therapeutic Challenge
Thrombus-in-transit is not uncommon in pulmonary embolism but Right Heart Transvalvular Embolus (RHTVE) complicating this is rare. A 54-year-old obese male with recent hospitalization presented with severe dyspnea and collapse. Initial investigations revealed elevated d-dimer and troponin. CTA show...
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| Format: | Article |
| Language: | English |
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Wiley
2015-01-01
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| Series: | Case Reports in Pulmonology |
| Online Access: | http://dx.doi.org/10.1155/2015/481357 |
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| author | Gyanendra Kumar Acharya Ajibola Monsur Adedayo Hejmadi Prabhu Derek R. Brinster Parvez Mir |
| author_facet | Gyanendra Kumar Acharya Ajibola Monsur Adedayo Hejmadi Prabhu Derek R. Brinster Parvez Mir |
| author_sort | Gyanendra Kumar Acharya |
| collection | DOAJ |
| description | Thrombus-in-transit is not uncommon in pulmonary embolism but Right Heart Transvalvular Embolus (RHTVE) complicating this is rare. A 54-year-old obese male with recent hospitalization presented with severe dyspnea and collapse. Initial investigations revealed elevated d-dimer and troponin. CTA showed saddle pulmonary embolus and bedside echocardiogram revealed right ventricular (RV) pressure overload and dilatation (RV > 41 mm), McConnell’s sign, and mobile echodensity attached to tricuspid valve. Patient was immediately resuscitated and promptly transferred for surgical embolectomy under cardiopulmonary bypass. A long segment of embolus traversing through the tricuspid valve and extensive bilateral pulmonary artery embolus were removed. IVC filter was placed for a persistent right lower extremity DVT. Hypercoagulable work-up was negative. Patient continued to do well after discharge on Coumadin. Open embolectomy offers great promises where there is no consensus in optimal management approach in such patients. Bedside echocardiogram is vital in risk stratification and deciding choice of advanced PE treatment. |
| format | Article |
| id | doaj-art-4ae056bc0cce4dd1a5284afc83691c8c |
| institution | Kabale University |
| issn | 2090-6846 2090-6854 |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Pulmonology |
| spelling | doaj-art-4ae056bc0cce4dd1a5284afc83691c8c2025-08-20T03:36:26ZengWileyCase Reports in Pulmonology2090-68462090-68542015-01-01201510.1155/2015/481357481357Right Heart Transvalvular Embolus with High Risk Pulmonary Embolism in a Recently Hospitalized Patient: A Case Report of a Therapeutic ChallengeGyanendra Kumar Acharya0Ajibola Monsur Adedayo1Hejmadi Prabhu2Derek R. Brinster3Parvez Mir4Department of Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY 11237, USADepartment of Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY 11237, USADivision of Cardiology, Department of Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY 11237, USADepartment of Cardiothoracic Surgery, Lenox Hill Hospital, North Shore-Long Island Jewish Health System, New York, NY 10075, USADivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY 11237, USAThrombus-in-transit is not uncommon in pulmonary embolism but Right Heart Transvalvular Embolus (RHTVE) complicating this is rare. A 54-year-old obese male with recent hospitalization presented with severe dyspnea and collapse. Initial investigations revealed elevated d-dimer and troponin. CTA showed saddle pulmonary embolus and bedside echocardiogram revealed right ventricular (RV) pressure overload and dilatation (RV > 41 mm), McConnell’s sign, and mobile echodensity attached to tricuspid valve. Patient was immediately resuscitated and promptly transferred for surgical embolectomy under cardiopulmonary bypass. A long segment of embolus traversing through the tricuspid valve and extensive bilateral pulmonary artery embolus were removed. IVC filter was placed for a persistent right lower extremity DVT. Hypercoagulable work-up was negative. Patient continued to do well after discharge on Coumadin. Open embolectomy offers great promises where there is no consensus in optimal management approach in such patients. Bedside echocardiogram is vital in risk stratification and deciding choice of advanced PE treatment.http://dx.doi.org/10.1155/2015/481357 |
| spellingShingle | Gyanendra Kumar Acharya Ajibola Monsur Adedayo Hejmadi Prabhu Derek R. Brinster Parvez Mir Right Heart Transvalvular Embolus with High Risk Pulmonary Embolism in a Recently Hospitalized Patient: A Case Report of a Therapeutic Challenge Case Reports in Pulmonology |
| title | Right Heart Transvalvular Embolus with High Risk Pulmonary Embolism in a Recently Hospitalized Patient: A Case Report of a Therapeutic Challenge |
| title_full | Right Heart Transvalvular Embolus with High Risk Pulmonary Embolism in a Recently Hospitalized Patient: A Case Report of a Therapeutic Challenge |
| title_fullStr | Right Heart Transvalvular Embolus with High Risk Pulmonary Embolism in a Recently Hospitalized Patient: A Case Report of a Therapeutic Challenge |
| title_full_unstemmed | Right Heart Transvalvular Embolus with High Risk Pulmonary Embolism in a Recently Hospitalized Patient: A Case Report of a Therapeutic Challenge |
| title_short | Right Heart Transvalvular Embolus with High Risk Pulmonary Embolism in a Recently Hospitalized Patient: A Case Report of a Therapeutic Challenge |
| title_sort | right heart transvalvular embolus with high risk pulmonary embolism in a recently hospitalized patient a case report of a therapeutic challenge |
| url | http://dx.doi.org/10.1155/2015/481357 |
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