Thrombolytic treatment of type A right atrial thrombi: description of three cases and review of the literature.

Type-A right atrial thrombosis is characterized by echocardiographic detection of mobile worm-shaped thromboemboli in the right atrium, with a high propensity to embolic dislocation into the pulmonary circulation. This type of thrombus is associated with a very high mortality rate that exceeds 60% in untreated patients. Surgical embolectomy has been proposed as the treatment of choice, but the availability of an experienced surgical staff and the patients' eligibility for surgical treatment cannot be taken for granted. Efficacy of systemic thrombolysis for treatment of type-A right atrial thrombosis has repeatedly been reported during the past few years, with early mortality rates comparable to those of surgical approach. The major advantages of thrombolysis would be ease of administration and independence of patient's hemodynamic status. Our experience confirms these impressions and argues in favor of the routine use of systemic thrombolysis in the presence of a type-A right atrial thrombus, while reserving surgical embolectomy for patients with formal contraindications to thrombolysis.