Key result
Urgent surgical excision and pulmonary embolectomy successfully treated a massive right atrial thrombus and pulmonary embolism in a 17-year-old male one year after ventricular septal defect repair.
Why the study?
Thromboembolic risk and preventive strategies following ventricular septal defect repair remain unclear, and right heart thrombi accompanied by pulmonary embolism are rare but life-threatening.
Case Report (n=1)
This case demonstrates that late right atrial thrombus and pulmonary embolism can occur after surgical VSD repair even without hypercoagulable states, and can be successfully managed with urgent surgical embolectomy.
Right heart thrombi are rare but life-threatening, with particularly high mortality when accompanied by pulmonary embolism (PE). Cardiac surgery may predispose to in-situ thrombus formation via suture lines or patch material, yet thromboembolic risk and preventive strategies following Ventricular Septal Defect (VSD) repair remain unclear. Here, we report a case of a young patient with a massive right atrial (RA) thrombus with PE one year after VSD repair in the absence of any known hypercoagulable state. A 17-year-old male with a history of surgical VSD repair one year earlier, who was not taking any antithrombotic therapy prior to presentation, presented with acute dyspnea, tachycardia, and severe hypoxia. Transthoracic echocardiography revealed a large, freely mobile RA mass. Subsequent CT pulmonary angiography and cardiac magnetic resonance confirmed a massive right pulmonary artery embolus and characterized the RA mass as an intracardiac thrombus. Because of clinical deterioration despite therapeutic anticoagulation, he underwent a successful urgent cardiac surgery with RA mass excision and pulmonary embolectomy. Postoperative histopathology confirmed the mass to be a thrombus. Our case highlights a rare late RA thrombus with PE one year after surgical VSD repair, requiring urgent surgery. Further research is needed to clarify post–VSD closure surveillance and thromboprophylaxis strategies.
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Elshaer et al. (2026) conducted a case report in Right atrial thrombus and pulmonary embolism (n=1). Surgical right atrial mass excision and pulmonary embolectomy was evaluated on Clinical recovery and successful mass excision. Urgent surgical excision and pulmonary embolectomy successfully treated a massive right atrial thrombus and pulmonary embolism in a 17-year-old male one year after ventricular septal defect repair.
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