Table of Contents Author Guidelines Submit a Manuscript
Case Reports in Pulmonology
Volume 2015, Article ID 481357, 4 pages
http://dx.doi.org/10.1155/2015/481357
Case Report

Right Heart Transvalvular Embolus with High Risk Pulmonary Embolism in a Recently Hospitalized Patient: A Case Report of a Therapeutic Challenge

1Department of Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY 11237, USA
2Division of Cardiology, Department of Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY 11237, USA
3Department of Cardiothoracic Surgery, Lenox Hill Hospital, North Shore-Long Island Jewish Health System, New York, NY 10075, USA
4Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY 11237, USA

Received 19 May 2015; Accepted 19 August 2015

Academic Editor: Akif Turna

Copyright © 2015 Gyanendra Kumar Acharya et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.