Copyright © 1989 by the European Society of Cardiology.
© 1989 The European Society of Cardiology
The European Cooperative Study on the clinical significance of right heart thrombi
THE EUROPEAN WORKING GROUP ON ECHOCARDIOGRAPHY andReceived 24 October 1988; revised 10 April 1989; .
Requests for reprints: G. Kronik MD, Dept for Internal Medicine and Cardiology, Regional Hospital Krems, Mitterweg 10, A-3500 Krems, Austria
Abstract
Information on a total of 119 patients with echocardiographically detected right heart thrombi was collected by questionnaire. Two major thrombus types with different morphology, etiology and clinical significance were identified: (1) 48 patients had long, thin, extremely mobile thrombi which resembled a worm or a snake (type A); (2) 57 patients had more or less immobile, non-specific clots resembling left heart thrombi (type B). Type A patients had a high incidence of deep venous thrombosis and a low incidence of potentially thrombogenetic cardiac abnormalities. The reverse was true for group B. These observations and the peculiar worm-shape of type A thrombi suggest that most type A thrombi originate in peripheral veins, while most type B thrombi develop within the right heart chambers. Clinically, type A patients were a high-risk group;pulmonary embolism was the rule andwas usually severe. Early (
8 days) thrombus-relatedmortality was excessively high (42%), including 13 deaths from pulmonary embolism, one from paradoxical peripheral embolism and six peri-operative deaths. Type B thrombi were much more benign;pulmonary embolism was not uncommon (40%) but never fatal. Early thrombus-relatedmortality was only 4% (two peri-operative deaths).
Fourteen cases could not be classified as A or B because their thrombi were highly mobile (= not B) but not worm-shaped (= not A). This small group was intermediate between groups A and B in all respects.
An analysis of the relationship between therapy and outcome revealed that type B thrombi had a good prognosis irrespective of the treatment. In type A cases early thrombus-related mortality was much lower with surgery (27%) than with conservative treatment (54%). However, the selection of surgical cases was certainly very biased and it is not clear to what extent the better results of surgery are caused by patient selection. Thus the optimal management of these cases remains to be determined.
Key Words: Thrombus • intracardiac thrombus • right heart thrombus • pulmonary embolism • echocardiography
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