Percutaneous treatment of a free-floating thrombus in the right atrium of a patient with pulmonary embolism and acute myocarditis

Abstract

Free-floating thrombi in the right atrium (RA) are extremely hazardous to patients with pulmonary thromboembolism, and optimal treatment methods remain unclear. We report a case of successful percutaneous intervention of a critical right atrial thrombus. The patient was a 50-year-old woman who had been under medication for acute myocarditis when she complained of sudden severe dyspnea. Echocardiography showed a mobile snake-like thrombus in the RA. The thrombus was pulled back to the distal inferior vena cava (IVC) using a catheter and an IVC filter was placed. Percutaneous treatment is useful for treating free-floating RA thrombi.

Free-Floating right heart thrombus with acute massive pulmonary embolism: A case report and review of the literature

“…Percutaneous interventional techniques can also be a good therapeutic option [ Table 1 ]. [ 27 ] Treatment should be individualized according to the patient's bleeding risk, hemodynamic parameters, and laboratory data. [ 5 ] Based on what has been mentioned in the literature review, there is still no consensus regarding the best treatment.…”

Pulmonary Embolism and Intracardiac Type A Thrombus with an Unexpected Outcome

“…Emerging catheter-directed therapies for PE include percutaneous catheter-directed thrombolysis or high-frequency ultrasound exposure near the surface of the clot; endovascular mechanical thrombectomy using fragmentation and a capture device; and endovascular aspiration of the clot directly from within the atrium, ventricle, or pulmonary arteries [15–17]. These methods are also promising in patients with RHT with some successful cases reported [18–21].…”

Mobile Intracardiac Mass after Inguinal Hernia Repair: An Unresolved Treatment Dilemma

“…Surgical embolectomy has been advocated as a rescue therapy [ 12 , 15 , 16 ]. Surgery has its inherent risks including the need to transport to a more experienced facility, anesthesia risk, and the inability to clear distal pulmonary circulation emboli [ 15 , 17 ]. Despite this, surgery may be the only option in a critically ill patient [ 18 – 20 ].…”

“…Catheter aspiration thrombectomy has also been used with success in few reported cases [ 17 , 21 ]. This modality may only be feasible in few highly specialized centers.…”