PMC5857334_01
Intraoperative 12 lead electrocardiogram demonstrating signs of acute cor pulmonale: S waves in lead 1 and Q waves with the suggestion of T wave inversion in lead 3.
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A 12-lead EKG showed signs of right heart strain, including an S wave in lead 1 and Q waves with T wave inversion in lead 3 (Figure 1). The apical four-chamber view revealed a mobile mass in the right atrium (RA) suspicious for a thrombus (Figure 2, Supplemental Video 1).
Intraoperative transthoracic echocardiography, 4 chamber apical view showing a right atrial thrombus (arrow), right ventricular dilatation, right atrial dilatation, and septal bowing. RV, right ventricle; RA, right atrium; IVS, interventricular septum; LA, left atrium; LV, left ventricle.
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The apical four-chamber view revealed a mobile mass in the right atrium (RA) suspicious for a thrombus (Figure 2, Supplemental Video 1). In the midesophageal 4-chamber view, a patent foramen ovale and associated RA thrombus were evident (Figure 3, Supplemental Video 2).
Initial intraoperative transesophageal echocardiography; midesophageal 4-chamber view. A large right atrial thrombus was visualized (blue arrow). LA, left atrium; RA, right atrium; RV, right ventricle.
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In the midesophageal 4-chamber view, a patent foramen ovale and associated RA thrombus were evident (Figure 3, Supplemental Video 2).
Perioperative chest computed tomography angiography; coronal reconstructions. (a) Filling defects were noted in right upper (red arrow) and lower lobar (green arrow) pulmonary arteries. (b) Right ventricular dilatation.
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CT angiography revealed RV dilatation with a large distal right PA thrombus extending into the upper and lower lobar arteries, along with a left upper and lower lobar artery thrombus (Figure 4).