Massive cardiac and pulmonary thrombi after cardiac surgery

Published:October 05, 2018DOI:
      A 32-year-old obese male with bicuspid aortic valve and severely dilated ascending aorta (59.5 mm) underwent hemi-arch aortic replacement and valvuloplasty on cardiopulmonary bypass. Due to progressive respiratory failure, veno-venous extracorporeal membrane oxygenation (ECMO) was started on postoperative day 4. On postoperative day 15, ECMO flow fell and the patient was progressively desaturating. Chest X-ray was normal. Trans-Oesophageal echocardiography revealed a mobile thrombus in the right atrium (Fig. 1, Panel A, asterisk) passing the tricuspid valve toward the right ventricle during systole (Supplementary video 1). Blood tests showed normal coagulation but low platelets (26,000/mm3 versus 160,000/mm3 at day 0). Following redo-sternotomy, a right atrial thrombus measuring 3 × 12 cm (Fig. 1, Panel B, left, Supplementary video 2) was removed. Intra-operatively, a second thrombus measuring 1.5 × 10 cm was discovered in the pulmonary artery and removed (Fig. 1, Panel B, right).
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