Successful Surgical Treatment of Entrapped Thrombus in Patent Foramen Ovale

Abstract

A year-old woman presented at our emergency clinic with sudden-onset dyspnoea, palpitations, chest pain, and left-leg swelling. She had hypotension and tachycardia. Transthoracic echocardiography showed a mobile, multilobular mass in the left atrium, attached to the interatrial septum. In addition, the right cardiac chambers were enlarged, and the pulmonary artery pressure was elevated, which suggested pulmonary embolism. For better delineation of the mass and atria, we performed transoesophageal echocardiography (TEE) which revealed a 8–11 mm thick, multilobular, homogeneously echogenic, and highly mobile mass extending from the right atrium to the left atrium through a patent foramen ovale (PFO) (Fig. 1 and Video 1) The patient’s respiratory and haemodynamic conditions worsened, and she was taken into emergency surgery. The operation was performed and a biatrial thrombus entrapped in a PFO was extracted. Also, the left and right pulmonary arteries were incised to the level of the segmental arteries, and pulmonary artery thrombi were removed via surgical embolectomy. The patient was successfully weaned from operation and there was no thrombus observed on the postoperative TEE. Impending paradoxical thromboembolism threatens the lives of patients who have a large thrombus that is entrapped in a PFO. Medical treatments or surgery can Figure 1. Transesophageal echocardiography shows a large mobile thrombus extending from the right to the left atrium through a patent foramen ovale.