Surgical treatment of mobile right atrial thrombus and pulmonary embolism due to protein C deficiency associated with patent foramen ovale

We present a case of a 36-year-old woman suffering from mobile right atrial thrombus and pulmonary embolism associated with cardiogenic shock. Two-dimensional echocardiography demonstrated a mass in the right atrium prolapsing through the tricuspid valve into the right ventricle during diastole, and leading to partial inflow obstruction. Computed tomography revealed a large mass into the left and right main pulmonary artery leading to obstruction. The laboratory findings of the patients revealed protein C deficiency. An emergency operation was performed and the thrombus in the right atrium and both pulmonary arteries were successfully extracted with using cardiopulmonary bypass. Previously unsuspected a large patent foramen ovale was closed primarily. This exemplary case highlights the benefit of surgical intervention rather than more conservative approaches such as anticoagulation and/or thrombolysis.