Percutaneous Thrombectomy for Clot-in-Transit With Concomitant Left Ventricular Thrombus in a Patient With Acute Heart Failure Exacerbation: A Case Report

Figures

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  Figure 1. CT pulmonary angiography demonstrating pulmonary embolism (PE). A. Coronal contrast-enhanced CT image showing an intraluminal filling defect within a left upper lobe pulmonary arterial branch. B. Axial CT image demonstrating a right main pulmonary artery filling defect, consistent with acute pulmonary embolism.

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  Figure 2. Right lower-extremity venous duplex ultrasound demonstrating DVT. Color Doppler image of the right popliteal vein demonstrating an intraluminal thrombus with reduced or absent venous flow, consistent with right popliteal DVT. DVT: Deep vein thrombosis.

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  Figure 3. Transthoracic echocardiography (TTE) demonstrating right-sided clot-in-transit and left ventricular apical thrombus. A. Echocardiographic view demonstrating a mobile right-sided intracardiac thrombus prolapsing across the tricuspid valve, indicated by the red arrows. B-C. Contrast-enhanced TTE images demonstrating a left ventricular apical filling defect consistent with thrombus, indicated by the red arrows and measurement calipers.

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  Figure 4. Three-dimensional (3D) and two-dimensional (2D) echocardiographic characterization of right-sided clot-in-transit. A. Three-dimensional transesophageal echocardiographic en face view of the tricuspid valve demonstrating an irregular, mobile echogenic mass at or near the tricuspid valve, indicated by the red arrow. B. Two-dimensional transesophageal echocardiographic view demonstrating a mobile right-sided thrombus, indicated by the red arrow. C. Echocardiographic view demonstrating a mobile right-sided intracardiac echodensity prolapsing across the tricuspid valve, consistent with clot-in-transit, indicated by the red arrows.

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  Figure 5. Transesophageal echocardiography (TEE) guidance during aspiration thrombectomy of right-sided clot-in-transit (CIT). A-C. Sequential TEE views demonstrating FlowTriever aspiration thrombectomy of a large, mobile right-sided intracardiac thrombus. Red arrows indicate the mobile echogenic thrombus within the right-sided cardiac chambers. D. Reinfusion of aspirated blood into the right-sided circulation.

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  Figure 6. Fluoroscopic stages of percutaneous aspiration thrombectomy. A. Large-bore aspiration catheter positioned within the right heart and pulmonary arterial circulation. B. Pulmonary angiography demonstrating right pulmonary arterial filling defects. C-D. Catheter advancement and repositioning for targeted aspiration thrombectomy. E. Post-thrombectomy angiography demonstrating improved distal pulmonary perfusion.