PMC8298113_01
A large, saddle pulmonary embolism (arrows) shown in computed tomography
angiogram of the chest, axial view.
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F1
Computed tomography angiogram of the chest revealed a large saddle embolism extending to the segmental branches, with right ventricular (RV) strain (Figure 1) as well as diffuse patchy ground-glass opacities consistent with COVID-19 pneumonia.
Fluoroscopic image of the SENTINEL cerebral embolic protection device (Boston
Scientific) with proximal basket in the brachiocephalic trunk and distal
basket in the proximal left carotid artery.
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F2
The SENTINEL cerebral protection system (SCPS, Boston Scientific) was deployed through a 6F sheath in the right radial artery (Figure 2), and the AngioVac system (Angiodynamics, Inc.) was deployed according to standard practice.
Transesophageal echocardiogram shows the AngioVac System cannula (arrow)
retrieved back into the right atrium across the patent foramen ovale. The
left atrial portion of the clot (X) is visualized, as is the right atrial
portion of the clot (*).
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F3
Using the 25F sheath, we inserted an AngioVac curved cannula into the right atrium to apply extracorporeal retrograde flow up to 3 L/min (Figure 3).
Transesophageal echocardiogram and clinical specimen. (A) Negative flow
applied using the AngioVac system's inflow aspirates the clots in a
retrograde fashion into the right atrium across the patent foramen ovale.
Microcavitation is seen on the right chamber and leftward interatrial
septum. (B) Post clot extraction. (C) Extracted specimen.
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F4
On inspection, the clot was already organized (Figure 4), and it was retrieved through the patent foramen ovale (PFO) without any systemic embolization.