On-pump Beating Heart Treatment in Pulmonary Embolism and Thrombus in Transit.

Thrombi in transit (TT) in right cavities are an infrequent event and it is a medical emergency with very high mortality rate. Without treatment, mortality rate is about 90-100%. Right heart thrombi occur in about 4% of pulmonary embolism (PE)1. Three types of right heart thrombi can be distinguished by echocardiography: type A is the most common one; it is usually the result of deep venous thrombosis and it has the highest risk of embolization. Type B thrombus is thought to originate within the atrium or ventricle, and it is firmly attached to the chamber wall and it frequently has an ovoid shape. Finally, type C thrombus is rare and highly mobile. It often resembles cardiac myxomas2. Treatment modalities include anticoagulation therapy, systemic thrombolysis, percutaneous or surgical embolectomy3. In other words, optimal therapeutic approach is still a subject of discussion. We present a patient with a type A thrombus treated through a surgical approach.