Totally thoracoscopic beating-heart resection of a catheter-related right atrial thrombus: a case report

Totally implantable venous access ports (TIVAPs) are widely used to provide reliable vascular access for chemotherapy in patients with malignancies. However, they may rarely give rise to catheter-related right atrial thrombus (CRAT), a potentially life-threatening complication. Here, we report a case of a patient with breast cancer who developed a right atrial thrombus following chemotherapy administered through a TIVAP. As anticoagulation therapy failed to resolve the thrombus, the patient subsequently underwent totally thoracoscopic beating-heart thrombectomy. Multimodality imaging played a pivotal role in localizing the intracardiac mass and characterizing its features, thereby guiding surgical planning. This case demonstrates that totally thoracoscopic beating-heart surgery is a safe and feasible treatment option for CRAT, offering favorable clinical outcomes and excellent cosmetic results, with promising potential for broader clinical application.