Original Article

Pulmonary Embolism and Right Heart Thrombi: A Single-Center Experience


Background: The right heart thrombus (RHT) embolizes from deep venous thrombi and sits in the right atrium or the right ventricle. We aimed to determine the occurrence and prognosis of the RHT in patients with pulmonary embolism.

Methods: We reviewed the cohort data of 622 patients with acute pulmonary embolism obtained from the registry of Tehran Heart Center. Demographic, physiological, clinical, and echocardiographic data, as well as clinical outcomes, were compared between patients with and without the RHT.

Results: The study population comprised 622 patients, including 329 men (52.8%). The mean age of the patients was 60.2±17.0 years. Thirty patients (4.8%) had echocardiographically proven RHT. Baseline demographic and clinical characteristics were not different between the 2 groups. Right ventricular dysfunction was more prevalent in the RHT (+) group, and more patients in this group were treated with thrombolysis (P=0.013 and P<0.001, respectively). Overall, 3 out of 21 patients (14.2%) in the RHT (+) group vs 29 out of 306 patients (9.4%) in the RHT (−) group died at 1 month (P=0.445) and 5 out of 21 patients (23.8%) in the RHT (+) group vs 56 out of 307 patients (18.2%) in the RHT (−) group died at 1 year (P=0.562).

Conclusion: The RHT is an influential complication in patients with pulmonary emboli, and it seems to increase the mortality rate of patients with acute pulmonary embolism.

1. Dalen JE. Free-Floating Right Heart Thrombi. Am J Med 2017;130:501.
2. Dzudovic B, Obradovic S, Rusovic S, Gligic B, Rafajlovski S, Romanovic R, Ratkovic N, Dincic D. Therapeutic approach in patients with a floating thrombus in the right heart. J Emerg Med 2013;44:e199-205.
3. Nkoke C, Faucher O, Camus L, Flork L. Free Floating Right Heart Thrombus Associated with Acute Pulmonary Embolism: An Unsettled Therapeutic Difficulty. Case Rep Cardiol 2015;2015:364780.
4. López-Jiménez L, Montero M, González-Fajardo JA, Arcelus JI, Suárez C, Lobo JL, Monreal M; RIETE Investigators. Venous thromboembolism in very elderly patients: findings from a prospective registry (RIETE). Haematologica 2006;91:1046-1051.
5. Muriel A, Jiménez D, Aujesky D, Bertoletti L, Decousus H, Laporte S, Mismetti P, Muñoz FJ, Yusen R, Monreal M; RIETE Investigators. Survival effects of inferior vena cava filter in patients with acute symptomatic venous thromboembolism and a significant bleeding risk. J Am Coll Cardiol 2014;63:1675-1683.
6. Riera-Mestre A, Jiménez D, Muriel A, Lobo JL, Moores L, Yusen RD, Casado I, Nauffal D, Oribe M, Monreal M; RIETE investigators. Thrombolytic therapy and outcome of patients with an acute symptomatic pulmonary embolism. J Thromb Haemost 2012;10:751-759.
7. Torbicki A, Galié N, Covezzoli A, Rossi E, De Rosa M, Goldhaber SZ; ICOPER Study Group. Right heart thrombi in pulmonary embolism: results from the International Cooperative Pulmonary Embolism Registry. J Am Coll Cardiol 2003;41:2245-2251.
8. Cameron J, Pohlner PG, Stafford EG, O'Brien MF, Bett JH, Murphy AL. Right heart thrombus: recognition, diagnosis and management. J Am Coll Cardiol 1985;5:1239-1243.
9. Kajamohideen N, Swaminathan N, Palanisamy G, Gnanavelu G, Sangareddi V. Morphology of right heart thrombi in pulmonary embolism: A case series and analysis. JIAE 2017;1:24-26.
10. Jenab Y, Lotfi-Tokaldany M, Alemzadeh-Ansari MJ, Seyyedi SR, Shirani S, Soudaee M, Ghaffari-Marandi N. Correlates of syncope in patients with acute pulmonary thromboembolism. Clin Appl Thromb Hemost 2015;21:772-776.
11. Barrios D, Rosa-Salazar V, Jiménez D, Morillo R, Muriel A, Del Toro J, López-Jiménez L, Farge-Bancel D, Yusen R, Monreal M; RIETE investigators. Right heart thrombi in pulmonary embolism. Eur Respir J 2016;48:1377-1385.
12. Haji Zeinali AM, Jenab Y, Ariannejad H, Kassaian SE, Alidoosti M, Aghajani H, Zafarghandi MR. Catheter-Directed Thrombolysis in Acute Iliofemoral Deep Vein Thrombosis with or without Stenting: A Case Series. J Teh Univ Heart Ctr 2018;13:186-190.
13. The European Cooperative Study on the clinical significance of right heart thrombi. European Working Group on Echocardiography. Eur Heart J 1989;10:1046-1059.
14. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, Huisman MV, Humbert M, Jennings CS, Jiménez D, Kucher N, Lang IM, Lankeit M, Lorusso R, Mazzolai L, Meneveau N, Áinle FN, Prandoni P, Pruszczyk P, Righini M, Torbicki A, Van Belle E, Zamorano JL; The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J 2019;54:1901647.
15. Islam M, Nesheim D, Acquah S, Kory P, Kourouni I, Ramesh N, Ehrlich M, Bajpayee G, Steiger D, Filopei J. Right Heart Thrombi: Patient Outcomes by Treatment Modality and Predictors of Mortality: A Pooled Analysis. J Intensive Care Med 2019;34:930-937.
16. Barrios D, Rosa-Salazar V, Morillo R, Nieto R, Fernández S, Zamorano JL, Monreal M, Torbicki A, Yusen RD, Jiménez D. Prognostic Significance of Right Heart Thrombi in Patients With Acute Symptomatic Pulmonary Embolism: Systematic Review and Meta-analysis. Chest 2017;151:409-416.
IssueVol 16 No 1 (2021): J Teh Univ Heart Ctr QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jthc.v16i1.6597
Right atrium Right ventricle Thrombosis Pulmonary embolism Survival

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How to Cite
Jenab Y, Ariannejad H, Rabbani Z, Soveyzi F, HosseinSabet A, Shirani S. Pulmonary Embolism and Right Heart Thrombi: A Single-Center Experience. J Tehran Heart Cent. 16(1):26-30.