Key result
Surgical removal under cardiopulmonary bypass successfully treated a patient with a Chiari network-trapped thromboembolus that was resistant to thrombolysis, possibly due to elevated PAI-1 levels.
Why the study?
Thromboemboli trapped in the Chiari network within the right atrium can be resistant to thrombolysis, and the mechanisms behind this resistance require elucidation.
Case Report (n=1)
Answers are grounded in this paper and cite their sources.
May prompt surgical extraction for thrombolysis-resistant Chiari network thrombi; leaves open PAI-1 contribution to organization.
This case report describes a patient with thromboemboli trapped in the Chiari network within the right side of the heart and resistant to thrombolysis. The right atrial masses were completely removed under cardiopulmonary bypass. Histological evaluation confirmed a mixed thromboemboli, with thrombus structures showing signs of organisation and surrounded by a fibrous capsule. The plasma level of the plasminogen activator inhibitor type-1 (PAI-1) was 50% higher than the normal upper limit. In this presented case, the Chiari network displayed a protective function but the expansion and organisation of the thromboembolus found there made it resistant to lytic treatment. Another important factor that could have influenced the resistance to thrombolysis was the high level of PAI-1.
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Motovska et al. (2010) conducted a case report in Thromboemboli in the Chiari network (n=1). Surgical removal under cardiopulmonary bypass was evaluated. Surgical removal under cardiopulmonary bypass successfully treated a patient with a Chiari network-trapped thromboembolus that was resistant to thrombolysis, possibly due to elevated PAI-1 levels.
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