Off-pump surgical thrombectomy for subacute right atrial thrombus: A case report

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Interventional Cardiology

Background:

• Right heart thrombi are a recognized complication of acute pulmonary embolism (PE).
• These thrombi are associated with a significantly higher mortality risk compared to PE without right heart involvement.
• Current treatment strategies include thrombolysis, catheter-based interventions, and open surgical thrombectomy, often requiring cardiopulmonary bypass.

Observation:

• Acute pulmonary embolism with a right atrial clot-in-transit presents a complex clinical scenario.
• Catheter-based interventions may fail to fully address large or mobile thrombi.
• Cardiopulmonary bypass, while effective for open surgery, carries substantial risks, particularly in high-risk patients.

Findings:

• This case report details a successful off-pump surgical thrombectomy for a right atrial clot-in-transit.
• The procedure was performed following the failure of a prior catheter-based intervention.
• Off-pump surgery avoided the complications associated with cardiopulmonary bypass.

Implications:

• Off-pump surgical thrombectomy represents a viable and potentially safer alternative for managing right atrial thrombi in select PE patients.
• This approach may be particularly beneficial for high-risk individuals where cardiopulmonary bypass is contraindicated.
• Further research into minimally invasive, off-pump techniques for complex PE cases is warranted.