Society for Vascular Medicine Abstracts presented at the SVM 2021 Virtual Scientific Sessions

Background: Right heart thrombi and thrombi in transit across a patent foramen ovale (PFO) are uncommonly seen in patients with pulmonary embolism (PE) and are associated with high risk of adverse outcomes. We present a case of bi-atrial thrombi and thrombus in transit in a patient with acute submassive PE. Methods/Case Description/Results: A 31-year-old male with no significant past medical history presented with 8 days of dyspnea on exertion and pleuritic chest pain. Computed tomography angiography showed large volume of bilateral PE with right ventricular (RV) strain and right atrial (RA) thrombus. He was hemodynamically stable. Cardiac biomarkers were elevated. COVID testing was negative. Pulmonary embolism response team (PERT) was activated. Transthoracic echocardiogram revealed severely dilated RV with severely reduced function. A mobile mass was seen in the RA, possibly anchored to the interatrial septum. An emergent transesophageal echocardiogram showed mobile thrombus within both atria and thrombus in transit through a PFO. After multidisciplinary PERT discussion, involving the patient and his family, decision was made to proceed with a surgical approach, including pulmonary artery and bi-atrial embolectomy, and PFO closure. Post-surgical recovery was uneventful, and he was discharged on aspirin and apixaban on postoperative day 6. Follow up TTE 4 weeks after discharge showed recovered RV size and function. The patient is back to normal functional status. Conclusion: Combined biatrial thrombi and thrombi in transit are rare in patients with PE. Multidisciplinary approach to such patients, taking into account risks and benefits of each treatment approach, and patient preferences, is of paramount importance to achieve optimal patient outcome..