Treatment of mobile right heart thrombi

Abstract

Right heart thrombi are detected in approximately 4% of patients with pulmonary embolism. The associated mortality is high, but the optimal strategy remains controversial. We report a case of a large mobile right heart thrombus, complicated by embolism of the right pulmonary artery, which was successfully treated with half-dose alteplase. We briefly review the literature and discuss the therapeutic options, focusing on the advantages of thrombolysis. LEARNING POINTS • Mobile right heart thrombi require rapid therapeutic choices between surgical thrombectomy and thrombolysis. • Half-dose alteplase may be effective, even in the presence of an extensive thrombus burden.