• Ahmed Al Badri, Chad Kliger, Dillon Weiss, Luigi Pirelli, Sean Wilson, Edward R DeLaney, Vladimir Jelnin, Itzhak Kronzon, Gila Perk, Jonathan M Hemli, Nirav C Patel, Suhail Raoof, and Carlos E Ruiz.
• Hackensack University Medical Center, 30 Prospect Avenue, 5 Main, Room 5640, Hackensack, NJ 07601 USA. cruizmd@gmail.com.
• J Invasive Cardiol. 2016 May 1; 28 (5): 196-201.

BackgroundRight heart thrombus in the absence of structural heart disease, atrial fibrillation, or intracardiac catheter is rare. It typically represents a thrombus migrating from the venous system to the lung, known as thrombi-in-transit, and can lead to a life-threatening pulmonary embolism. The optimal therapy for thrombi-in-transit remains controversial. We report our experience using percutaneous removal of right heart thrombus using vacuum aspiration.MethodsPatients with right atrial mass who were hemodynamically stable and underwent vacuum thombectomy using the AngioVac system (AngioDynamics) at our institution were included in this analysis. Between December 2012 and August 2014, a total of 7 patients (2 men, 5 women) with a mean age of 51.5 years (range, 20-83 years) underwent right atrial thrombectomy. Data during the procedure and follow-up period were collected and analyzed.ResultsAll patients were hemodynamically stable before the procedure. The procedure was considered successful in 6 patients. All patients survived through hospitalization. No periprocedural bleeding, stroke, or myocardial infarction occurred. One patient developed cardiogenic shock after the procedure that required extracorporeal membrane oxygenation support for <24 hours. There was no recurrent venous thromboembolism at a mean follow-up of 9 months.ConclusionVacuum-assisted thrombectomy can be a potential treatment option for hemodynamically stable patients with large right-sided intracardiac thrombus who are not surgical candidates.

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