Large right atrial thrombus associated with central venous catheter requiring open heart surgery

Area of Science:

• Cardiology
• Vascular Surgery
• Nephrology

Background:

• Central venous catheters (CVCs) are widely used in clinical settings.
• CVC-related right atrial thrombosis (CRAT) presents variable incidences but carries high mortality risks, especially in non-hemodialysis patients (>40%).
• Pathogenic mechanisms for CRAT include mechanical irritation, clot propagation, hypercoagulability, and altered right atrial hemodynamics.

Purpose of the Study:

• To report a case of successful open heart surgery for a large CRAT in an asymptomatic patient.
• To emphasize the importance of early CRAT detection and its impact on prognosis.
• To highlight the role of transesophageal echocardiography in CRAT diagnosis and treatment guidance.

Main Methods:

• Case report of a 59-year-old male undergoing preoperative evaluation for kidney transplant.
• Diagnosis of a large CRAT via transesophageal echocardiography.
• Successful treatment with open heart surgery after medical management failure.

Main Results:

• The patient, initially asymptomatic, was successfully treated with open heart surgery for a large CRAT.
• Early detection of CRAT was crucial for a favorable outcome, avoiding catastrophic complications.
• Transesophageal echocardiography proved vital in detecting the thrombus and potentially guiding treatment decisions.

Conclusions:

• Early detection of CRAT is critical for improving patient prognosis.
• Open heart surgery can be an effective treatment for large CRAT, particularly after medical treatment failure.
• Transesophageal echocardiography plays a key role in diagnosing CRAT and informing treatment strategies.