Right Atrial Thrombi, the Management Conundrum: 2 Case Reports

Area of Science:

• Cardiology
• Vascular Medicine
• Interventional Cardiology

Background:

• Currently, no established guidelines exist for managing right atrial thrombi due to limited supporting evidence.
• This case series examines two high-risk patients with massive right atrial thrombi, presenting distinct clinical scenarios and treatment outcomes.

Observation:

• Case 1 involved a 62-year-old male with ischemic cardiomyopathy and atrial fibrillation presenting with shortness of breath; cardiac ultrasound revealed a large right atrial thrombus without pulmonary emboli.
• Case 2 involved a 66-year-old male with nonischemic cardiomyopathy, atrial fibrillation, and a history of deep venous thrombosis and pulmonary emboli, presenting with sudden shortness of breath and confirmed bilateral pulmonary emboli.

Findings:

• Case 1 was successfully managed with heparin infusion and thrombolytic therapy, showing a favorable outcome.
• Case 2 required heparin infusion, EkoSonic endovascular therapy, venoarterial extracorporeal membrane oxygenation, and mechanical aspiration thrombectomy, ultimately resulting in an unfavorable outcome.

Implications:

• Individualized management strategies are crucial for right atrial thrombi, considering thrombus characteristics, hemodynamic stability, and the presence of pulmonary emboli.
• Further research and evidence-based guidelines are needed to standardize the treatment of right atrial thrombi.