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Vol. 65. Issue 7.
Pages 398-402 (August - September 2018)
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Vol. 65. Issue 7.
Pages 398-402 (August - September 2018)
Case report
Open heart surgery for management of right auricular thrombus related to central venous catheterization
Cirugía a corazón abierto para el tratamiento de trombo auricular derecho relacionado con cateterización venosa central
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A.F. Ribeiroa,
Corresponding author
ana.filipa.ribeiro@gmail.com

Corresponding author.
, I.S. Netob, I. Maiac, C. Diasc
a Department of Anesthesiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
b Department of Anesthesiology, Centro Hospitalar de São João, Porto, Portugal
c Neurocritical Care Unit, Intensive Care Department, Centro Hospitalar de São João, Porto, Portugal
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Abstract

Central venous catheters are widely used in critically ill patients; however, they are also associated with increased morbidity and mortality. The literature may underestimate the incidence of catheter-inducible right atrial thrombi that are asymptomatic but potentially life threatening. The recognized risk factors for its development include infections related to the catheter, endothelial injury secondary to mechanical and chemical damage induced by certain medications and infused fluids. The characteristics of the patient and the catheter, such as size, material, type, location and ease of insertion, as well as the duration of placement play an additional role.

We report the case of a 38-year-old man, who developed an asymptomatic catheter-inducible right atrial thrombi requiring open-heart surgery, after taking a central venous catheter for thirty-five days. The present case highlights existing limitations in making a correct and fast diagnosis, which should be anticipated in patients with multiple risk factors for thrombosis. Given the limited recommendations available, we consider that the most appropriate strategy should be individualized.

Keywords:
Central venous catheter
Catheter-related thrombosis
Calcified right atrial thrombus
Surgical removal
Thrombolysis
Resumen

Los catéteres venosos centrales se utilizan de manera generalizada en pacientes críticos; sin embargo, también se asocian a una elevada morbimortalidad. La literatura puede subestimar la incidencia de los trombos auriculares derechos asociados a catéter venoso, que son asintomáticos, pero potencialmente de riesgo. Los factores de riesgo reconocidos para su desarrollo incluyen infecciones relativas al catéter y lesiones endoteliales secundarias al daño mecánico y químico inducido por ciertos fármacos y líquidos infundidos. También desempeñan un papel añadido las características del paciente y del catéter, tales como tamaño, material, tipo, localización y facilidad de inserción, y duración de la misma.

Reportamos el caso de un varón de 38 años que desarrolló trombos auriculares derechos asintomáticos asociados a catéter venoso y precisó cirugía a corazón abierto tras cateterización venosa central durante 35días. El presente caso destaca las limitaciones existentes a la hora de realizar un diagnóstico correcto y rápido, que debería anticiparse en pacientes con factores de riesgo múltiples de trombosis. Dadas las recomendaciones disponibles limitadas, consideramos que debería individualizarse la estrategia más adecuada.

Palabras clave:
Catéter venoso central
Trombosis asociada a catéter
Trombo auricular derecho calcificado
Extirpación quirúrgica
Trombólisis

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