Quadruple-Chamber Clot in Transit Traversing a Patent Foramen Ovale: Successful Percutaneous Mechanical Thrombectomy

Clot in transit (CIT) is a rare, life-threatening manifestation of venous thromboembolism. When a thrombus traverses a patent foramen ovale, the risk of systemic embolization increases, and optimal management remains undefined.

A 73-year-old woman presented with dyspnea and saddle pulmonary embolism with right heart strain. Echocardiography revealed a serpentine thrombus extending from the right atrium across the tricuspid valve, traversing a patent foramen ovale into the left atrium, and prolapsing through the mitral valve. After multidisciplinary discussion, she underwent mechanical thrombectomy with removal of a 14 cm intracardiac thrombus and pulmonary emboli. She recovered without clinically apparent systemic embolization.

Quadruple-chamber CIT with transseptal extension is exceedingly rare and carries high embolic risk. This case highlights mechanical thrombectomy as an alternative to surgery in selected patients.

Mechanical thrombectomy may represent an effective and less invasive option for complex biatrial and biventricular CIT with pulmonary embolism.