Selective Right Atrial Thrombectomy for Clot-in-Transit With Dynamic Tricuspid Inflow Obstruction Complicating Acute...

Area of Science:

• Cardiology
• Radiology
• Interventional Cardiology

Background:

• Acute pulmonary embolism (PE) can lead to hemodynamic compromise.
• Right atrial clot-in-transit (CIT) is a rare but serious complication of PE.
• CIT can cause dynamic obstruction of tricuspid valve inflow, contributing to shock.

Purpose of the Study:

• To describe a case of acute PE with RA CIT causing dynamic tricuspid inflow obstruction.
• To highlight the role of imaging in diagnosing this condition.
• To evaluate the efficacy of selective intracardiac thrombectomy in managing this critical scenario.

Main Methods:

• Computed tomography (CT) and transthoracic echocardiography (TTE) were used for diagnosis.
• A 96-year-old female patient with recurrent syncope, hypoxia, and shock was evaluated.
• Selective right atrial (RA) aspiration thrombectomy was performed due to contraindications for systemic thrombolysis.

Main Results:

• Imaging revealed acute PE with right ventricular dilation and a mobile RA CIT.
• The CIT intermittently prolapsed across the tricuspid valve, causing dynamic obstruction.
• Successful RA aspiration thrombectomy removed a 15-cm thrombus, leading to immediate hemodynamic improvement.

Conclusions:

• Dynamic tricuspid inflow obstruction by RA CIT can precipitate shock in acute PE.
• Selective intracardiac thrombectomy is a viable and rapid therapeutic option for hemodynamic stabilization in such cases.
• This case underscores the importance of considering CIT in the differential diagnosis of shock in PE.