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Updated: Aug 6, 2026

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Selective Right Atrial Thrombectomy for Clot-in-Transit With Dynamic Tricuspid Inflow Obstruction Complicating Acute
Elene Shavgulidze1, Wilson K Roosevelt2, Raymond J Foley3
1Department of Internal Medicine, University of Connecticut School of Medicine, UConn Health, Farmington, Connecticut, USA.
Image(S):
Computed tomography and transthoracic echocardiography demonstrating right atrial (RA) clot-in-transit (CIT) causing dynamic tricuspid inflow obstruction in acute pulmonary embolism.
Case Summary:
A 96-year-old woman presented with recurrent syncope, hypoxia, and shock requiring vasopressor support. Imaging demonstrated acute pulmonary embolism with right ventricular dilation/dysfunction and a mobile RA CIT intermittently prolapsing across the tricuspid valve. Systemic thrombolysis was contraindicated because of recent ischemic stroke. Selective RA aspiration thrombectomy removed a 15-cm thrombus, resulting in immediate hemodynamic improvement.
Take-Home Messages:
Dynamic tricuspid inflow obstruction may contribute to shock in CIT complicating acute pulmonary embolism. Selective intracardiac thrombectomy may rapidly restore hemodynamic stability.
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