The removal of floating right heart thrombi and pulmonary embolus using AngioJet device and venoarterial extracorporeal membrane oxygenation: a case report

BACKGROUND: Floating right heart thrombi (FRHTS), known as thrombi in transit, are usually located in the atrium or ventricle. Generally, it occurs in patients with pulmonary embolism (PE) and dyspnea, chest pain, syncope and palpitations are the most common symptoms on presentation. The mortality of patients with FRHTS is higher than that of those without FRHTS. Current treatment includes anticoagulation, systemic thrombolysis, catheter directed interventions, and surgical embolectomy. However, there is no consensus on the optimal management options. CASE DESCRIPTION: Herein, we report the case of a patient who presented with hypotension and tachycardia accompanied by an asymptomatic right leg deep vein thrombosis, right atrial thrombus, and pulmonary embolus. He had a history of radical resection of colon cancer 1 month prior. And he had developed chest tightness accompanied by stabbing pain in the chest area 1 day ago. He experienced an episode of syncope 8.5 hours ago. So he was referred to the local hospital. After the pulmonary computed tomography angiography (CTA) scan, he was diagnosed with pulmonary embolus and administrated with 5,000 u low molecular weight heparin. Then he was transferred to our hospital. On arrival in the emergency department, the bedside transthoracic echocardiography (TTE) revealed there was an enlarged right atrium and right ventricle, with a floating right atrial mass prolapsing through the tricuspid valve during diastole. The patient accepted anticoagulation treatment, but refused to undergo thrombolysis or surgical embolectomy. Eventually, the right heart thrombi (RiHT) floated to the left main branch of pulmonary artery. It was successfully treated by using AngioJet device and venoarterial extracorporeal membrane oxygenation (VA-ECMO). Our case provides clinical evidence supporting the feasibility and efficacy of AngioJet device and VA-ECMO in the treatment of the RiHT and PE. CONCLUSIONS: Patients with PE combined with RiHT have higher mortality than those without RiHT, VA-ECMO could be used to maintain the circulation, and the AngioJet device could be used as an alternative treatment for patients who are reluctant to receive thrombolysis or surgical embolectomy.