Percutaneous Thrombectomy of a Thrombus in Transit Through a Patent Foramen Ovale: A Novel Approach

Background: Transcatheter vacuum-assisted mass extraction is a safe alternative to surgical thrombectomy in high-risk patients, although experience with left-sided intracardiac material is limited. Case Presentation: A 19-year-old man with newly diagnosed Hodgkin lymphoma developed airway compromise, cardiac tamponade, massive pulmonary embolism, and cardiogenic shock requiring venoarterial-venous extracorporeal membrane oxygenation. Echocardiography showed a mobile biatrial thrombus traversing a patent foramen ovale. Because of prohibitive surgical risk, he underwent AngioVac (AngioDynamics, Inc) thrombectomy with bilateral cerebral embolic protection, transient aortic flow arrest, and septal occluder–mediated thrombus entrapment, with hemodynamic stabilization and no stroke on follow-up imaging. Discussion: In a patient with biatrial thrombus and prohibitive surgical risk, percutaneous AngioVac thrombectomy provided a feasible alternative to open thrombectomy. Cerebral protection, transient interruption of antegrade aortic flow during left atrial aspiration, and septal occluder–mediated thrombus containment addressed the major risk of systemic embolization. Take-Home Messages: Biatrial thrombus traversing a patent foramen ovale requires treatment planning that accounts for both pulmonary and systemic embolic risk. In selected inoperable patients, cerebral protection, temporary aortic flow arrest, vacuum-assisted aspiration, and septal occluder–mediated thrombus entrapment can be considered within a multidisciplinary strategy.