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Free-floating thrombi in the right heart chambers is a rare phenomenon. Nearly 99% of detected cases are associated with the presence of proven pulmonary embolism. Its presence is associated with a poor outcome with a mortality between 27 to 44% according to studies. Despite the emergency of treatment, optimal management of free floating right heart thrombus remains controversial with no clear consensus. We present the case of a 84-year-old man hospitalised for acute decompensated heart failure. After an initial favourable evolution, a degradation of respiratory occurred with dyspnea and desaturation. A bedside transthoracic echocardiography showed a mobile serpiginous thrombus, 7cm size, moving to and across the tricuspid valve. A computed tomography of the chest demonstrated massive bilateral pulmonary embolism. After persistence of the thrombus and seven days of heparinotherapy, thrombolysis therapy was initiated. The thrombus disappeared 24h after thrombolysis. Without contra-indication, thrombolysis is a faster, readily available treatment for the management of floating thrombus in the right heart chambers associated with pulmonary embolism.

Free-floating thrombi in the right heart chambers is a rare phenomenon. Nearly 99% of detected cases are associated with the presence of proven pulmonary embolism. Its presence is associated with a poor outcome with a mortality between 27 to 44% according to studies. Despite the emergency of treatment, optimal management of free floating right heart thrombus remains controversial with no clear consensus. We present the case of a 84-year-old man hospitalised for acute decompensated heart failure. After an initial favourable evolution, a degradation of respiratory occurred with dyspnea and desaturation. A bedside transthoracic echocardiography showed a mobile serpiginous thrombus, 7cm size, moving to and across the tricuspid valve. A computed tomography of the chest demonstrated massive bilateral pulmonary embolism. After persistence of the thrombus and seven days of heparinotherapy, thrombolysis therapy was initiated. The thrombus disappeared 24h after thrombolysis. Without contra-indication, thrombolysis is a faster, readily available treatment for the management of floating thrombus in the right heart chambers associated with pulmonary embolism.

Recent studies have demonstrated that cardiac resynchronization therapy diminish morbidity and mortality of patients with heart failure, who remain symptomatic despite an optimal medical treatment and who have a wide QRS. However, 30% of patients are non-responders. Hence, echocardiography constitutes an interesting tool for the diagnosis of asynchrony. Different echocardiographic indices predict response to cardiac resynchronization therapy. In this article, a practical approach is proposed for these patients.

Recent studies have demonstrated that cardiac resynchronization therapy diminish morbidity and mortality of patients with heart failure, who remain symptomatic despite an optimal medical treatment and who have a wide QRS. However, 30% of patients are non-responders. Hence, echocardiography constitutes an interesting tool for the diagnosis of asynchrony. Different echocardiographic indices predict response to cardiac resynchronization therapy. In this article, a practical approach is proposed for these patients.