A rare case of a cardiac calcified thrombus originating from right atrium and inferior vena cava

Cisico, Stefano; Vacirca, Sara Rita; Basso, Cristina; Milardi, Domenico

doi:10.1111/jocs.14443

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…Even though the TTE, a noninvasive method, is considered the imaging modality of choice for the diagnosis of cardiac myxoma, a transesophageal approach provides a better definition of the location and characteristics of the tumor with a sensitivity of almost 100%. [ 8 ]…”

Section: Discussionmentioning

confidence: 99%

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A Case of Dyspnea in a Patient with a Previous Coronavirus Disease Infection

Tripodi

Bellieni

Scigliano

et al. 2022

Journal of Cardiovascular Echography

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Myxoma is the most common benign primary tumor of the heart. Diagnosis of cardiac myxoma is difficult as it presents itself with varying nonspecific symptoms, and an echocardiography can easily diagnose it. Sometimes, it can cause cardiac syncope and thromboembolic events. A woman with a recent infection by severe acute respiratory syndrome coronavirus-2 was admitted to our hospital with respiratory symptoms: dyspnea and tachypnea; cardiac symptoms: atrial fibrillation; and neurological symptoms: syncope. Initially, she performed brain computed tomography (CT) and CT angiography value. Transthoracic echocardiogram and transesophageal echocardiogram showed an atrial mobile mass. Chest X-ray did not show any interstitial lesions. Therefore, urgent cardiac surgery was performed to remove the mass. The histological examination confirmed the presence of a cardiac myxoma. Our experience could show the importance of early diagnosis and prompt surgical treatment to prevent stroke.

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Section: Discussionmentioning

confidence: 99%

“…Surgical removal of cardiac mass remains the definitive treatment and is fundamental to achieve the correct diagnosis and to avoid inferior vena cava occlusion or thromboembolic risks. [ 8 ]…”

Section: Onclusionsmentioning

confidence: 99%

A Case of Dyspnea in a Patient with a Previous Coronavirus Disease Infection

Tripodi

Bellieni

Scigliano

et al. 2022

Journal of Cardiovascular Echography

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“…Treatment can range from antiplatelet, anticoagulation, or thrombolytic therapy to invasive options such as surgical or percutaneous removal [ 3 , 4 ]. Invasive excision can be necessary for accurate diagnosis and prevention of embolic events [ 5 , 6 ]. However, extensive calcified right atrial thrombus can result in inferior vena cava occlusion [ 5 ] and involvement of the tricuspid valve may precipitate tricuspid regurgitation which would necessitate surgical repair [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Successful tricuspid valve repair and right atrial mass excision for calcified thrombus causing severe tricuspid regurgitation and near-occlusion of inferior vena cava

Pennacchio,

Rosinski,

Grimm

et al. 2024

J Cardiothorac Surg

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Background Calcified right atrial thrombus is rare and commonly occurs secondary to atrial fibrillation and long-term central venous catheterization which present risk for embolization. Treatment typically involves anticoagulation and antiplatelet therapy but rarely surgical excision can be performed, especially in patients with venous obstruction or concomitant valvular dysfunction. Case presentation We present the case of a 69 year old symptomatic female with a history of atrial fibrillation and long-term venous catheterization found to have a large calcified right atrial thrombus causing inferior vena cava obstruction and severe tricuspid regurgitation. Patient underwent full median sternotomy with ascending arterial cannulation with superior vena cava and femoral venous cannulation. Intraoperatively, extensive right atrial calcified thrombus was found extending into the inferior vena cava and involving the septal portion of the tricuspid valve annulus causing regurgitation. The calcified thrombus was removed which resolved the inferior vena cava obstruction and the tricuspid valve was repaired by transecting septal leaflet chordae, commissuroplasty, and ring annuloplasty. Postoperative course was uncomplicated and pathology confirmed a calcified right atrial thrombus. At 6 month follow up, the patient was asymptomatic with echocardiogram showing no inferior vena cava stenosis and trivial tricuspid regurgitation. Conclusions Surgical excision of calcified right atrial thrombus is rare and is often indicated for symptomatic patients with extensive involvement causing venous inflow obstruction or valvular dysfunction. Sufficient preoperative imaging and a multi-disciplinary approach are essential for accurate diagnosis to guide targeted treatment. When the tricuspid valve is involved, repair is preferred over replacement in this patient population given their propensity for calcification and thrombus formation which may result in an increased risk of early bioprosthetic valve degeneration or mechanical valve thrombosis.

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