PMC9489941_01
Preoperative imaging examination. (A) Brain CT manifested as post-infraction of cerebral lacunar with no other significant abnormalities. (B,C) Pulmonary CT angiography presented embolism in the distal of the right pulmonary artery and its branches. (D-F) Preoperative TTE showed a 13 x 9 mm thrombus floating in the left atrium without a shunt. White arrows represent thrombus.
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Brain CT manifested as post-infarction of cerebral lacunar with no significant abnormalities (Figure 1A). Pulmonary CT angiography presented an embolism in the distal of the right pulmonary artery and its branches (Figures 1B,C). Transthoracic echocardiography (TTE) showed a 13 x 9 mm hypoechoic mass attached to the left-atrial side of the device, which was suspected to be either a neoplasm or thrombus (Figures 1D-F).
Intraoperative TEE and surgical images. (A,D) 2D-TEE color Doppler showed an ASD device with a double-sided thrombus. (B,E) 3D-TEE demonstrated a fan-like left-atrial thrombus attached to the device and a short rod-like right-atrial thrombus attached to the device. (C,F) Surgical resection of ASD device fragments with bilateral thrombus. (G) Biplanar TEE showed a giant thrombus floating in the left atrium. (H) Left atriotomy showed a white thrombus attached to the device. (I) Postoperative TEE showed continuous atrial septum without shunt and thrombus. TEE, transesophageal echocardiography; ASD, atrial septal defect. White arrows represent thrombus.
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Three-dimensional TEE revealed fan-like vegetation (21 x 16 mm) attached to the left-atrial side of the device and short rod-like vegetation (8 x 6 mm) attached to the right-atrial side (Figure 2; Supplementary Videos 1-3).
Postoperative TTE images. (A,B) TTE images 1 month after surgery showed continuous atrial septum without shunt and thrombus. (C,D) Three-month postoperative TTE images showed no novel shunt and no thrombus. TTE, transthoracic echocardiography.
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Three months after the operation, ultrasonography and laboratory examinations revealed that the atrial septum was structurally intact without shunts, and there was no thrombus found in the atrium, internal jugular vein, or deep veins of the lower extremities, along with normal blood counts and coagulation function (Figure 3).