Echocardiography in planned interruption of the inferior vena cava

Interruption of the inferior vena cava by the transvenous placement of a filter or umbrella effectively prevents pulmonary embolism by acting primarily as a physical barrier to emboli. Such a device will be effective only if the site of thrombosis is distal to the planned placement site. We have presented two cases in which a preoperative echocardiogram revealed a right atrial embolus, thereby mandating either embolectomy, fibrinolytic therapy, or continued anticoagulation in addition to the filter placement. These cases suggest that an echocardiogram should be included in the evaluation preceding interruption of the inferior vena cava.