Rare Right Atrial Thrombus Deferred Atrial Septal Defect Closure and Implantable Cardioverter-Defibrillator Placement

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Interventional Cardiology

Background:

• Nonischemic cardiomyopathy and atrial septal defect (ASD) present unique clinical challenges.
• Right atrial thrombi are uncommon, particularly in patients without atrial arrhythmias or implanted devices.
• Percutaneous ASD closure and implantable cardioverter-defibrillator (ICD) placement are common procedures requiring careful preprocedural evaluation.

Purpose of the Study:

• To report a rare case of right atrial thrombus discovered during preprocedural imaging for atrial septal defect (ASD) closure.
• To emphasize the significance of preprocedural echocardiography in identifying unexpected cardiac masses.
• To highlight the potential risks of embolic complications in patients with cardiac anomalies.

Main Methods:

• A 47-year-old male patient with nonischemic cardiomyopathy and ASD was evaluated.
• Transesophageal echocardiography (TEE) was performed prior to planned percutaneous ASD closure and ICD placement.
• The patient was subsequently managed conservatively with warfarin anticoagulation.

Main Results:

• Preprocedural TEE unexpectedly revealed a large right atrial thrombus.
• Both planned procedures (ASD closure and ICD placement) were canceled due to the thrombus.
• Conservative management with warfarin was initiated.

Conclusions:

• This case represents the first reported instance of a right atrial thrombus detected during the workup for ASD closure.
• The findings underscore the critical role of thorough preprocedural imaging to prevent potentially life-threatening embolic events.
• Right atrial thrombus formation can occur even in the absence of typical risk factors like atrial arrhythmia or indwelling devices.