Diagnosis of a huge right atrial thrombus during coronary artery bypass graft surgery

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Critical Care Medicine

Background:

• Intra-operative thrombus formation in the right heart is a rare occurrence.
• Undetected cardiac thrombi can lead to severe complications such as pulmonary embolism and mortality.
• Prompt recognition and management are critical.

Purpose of the Study:

• To report a rare case of intra-operative right heart thrombus during coronary artery bypass grafting (CABG).
• To highlight the importance of transesophageal echocardiogram (TEE) in diagnosing and managing such critical events.
• To emphasize the role of TEE in preoperative evaluation for pulmonary hypertension.

Main Methods:

• A case report of a 73-year-old male patient presenting with angina pectoris and shortness of breath.
• Coronary artery bypass grafting (CABG) was performed for multi-vessel disease.
• Intra-operative transesophageal echocardiogram (TEE) revealed a large free-floating thrombus in the right heart and pulmonary arteries.

Main Results:

• Multiple thrombi were successfully removed from the right heart and pulmonary arteries.
• Despite intervention, the patient experienced hemodynamic insufficiency and ultimately died after intensive care.
• The case underscores the challenges in managing intra-operative cardiac thrombi.

Conclusions:

• Transesophageal echocardiogram (TEE) is vital for intra-operative assessment during CABG.
• TEE plays a critical role in the preoperative evaluation of patients with suspected pulmonary hypertension.
• Early detection and intervention for intra-operative thrombi can improve patient outcomes, though challenges remain.