Right heart thrombus

Thrombus in the right heart chambers is a rare condition. Free-floating right heart thrombi can be the result of dislodged thrombi from the venous system and subsequently may travel to the pulmonary vasculature causing pulmonary emboli. Structural problems in the heart, atrial fibrillation, or presence of a foreign object, such as catheter or pacemaker leads, in the superior vena cava or in the heart chamber may increase the risk of thrombus formation. Clot size, its location, overall body clot burden, and presence of patent foramen ovale determine the clinical consequences and therapeutic approach to a thrombus located in the right heart. Pulmonary embolism is expected in most patients. Sudden cardiovascular collapse is the worst outcome if thrombus compromises the circulation in the valvular structures or main pulmonary vasculature. The optimal therapy for right-sided heart thrombus remains controversial. This review focuses on the etiology, diagnosis, and management of right heart thrombus.