The Conundrum of Managing a Giant Right Atrial Thrombus

Chan, Po-Fun; Lin, Wenhua; Kristanto, William; Lim, Toon Wei

doi:10.1016/s0735-1097(16)31186-x

Cited by 1 publication

(1 citation statement)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of note also, thrombolytics and anticoagulation in these cases are assailed by some for a theoretic risk of dissolving the thrombus stalk consequently untethering the mass for embolization. 6 Surgical embolectomy was offered but the patient declined. The AngioVac device was deemed most appropriate given success rates in prior cases series however, its risk-benefit profile outside of the setting of acute pulmonary embolism and with such a precariously situated mass was unknown.…”

Section: Discussionmentioning

confidence: 99%

Suction thrombectomy of a massive, hypermobile (type C) right atrial thrombus: a case report

Reddy

Kwan

Latouff

et al. 2021

European Heart Journal - Case Reports

View full text Add to dashboard Cite

Background Right atrial thrombus (RAT) may be managed according to morphology and aetiology, i.e. Type A thrombi (‘clot-in-transit’, hypermobile) are managed with thrombolytics and surgical embolectomy due to high risk of embolization; Type B thrombi (broad-based, globular) may be managed medically as they will very likely maintain a benign course. Experience with management of a Type C thrombus (hypermobile but also broad-based) has not been explicitly described in the literature. Case summary A 25-year-old man with history of leukaemia with prior right subclavian vein chemoport is found to have massive RAT. Multimodal imaging shows a hypermobile mass attached to the right atrial lateral wall inferior to superior vena cava and prolapsing into right ventricle in diastole. Given the thrombus morphology and likely propagation from subclavian port, risk of catastrophic embolization was deemed high and as such, intervention was indicated. Systemic anticoagulation was considered but deferred due to theoretical risk of dissolving the thrombus stalk leading to embolization. Surgical thrombectomy was offered but the patient declined. Due to evidence for success in RAT, the AngioVac System: Generation 3 (Angiodynamics, Inc., Latham, NY, USA) was chosen for intervention. The RAT was successfully removed without any complication. Discussion AngioVac suction thrombectomy is a safe alternative option for removal of a Type C, massive, hypermobile RAT.

show abstract

Section: Discussionmentioning

confidence: 99%