Diagnosis of a huge right atrial thrombus during coronary artery bypass graft surgery

PATIENT Male, 73 FINAL DIAGNOSIS: Coronary artery thrombosis Symptoms: Angina pectoris • short of breath MEDICATION - Clinical Procedure: CABG Specialty: Cardiology. OBJECTIVE Management of emergency care. BACKGROUND Intra-operative formation of a thrombus in the right heart is rare and might be unrecognized. However, it can be associated with severe consequences, including pulmonary embolism and death. CASE REPORT We report the case of a 73-year-old man who presented to the cardiologist with angina pectoris and rare shortness of breath. Coronary artery bypass grafting (CABG) was performed due to multi-vessel disease. Because of hemodynamic insufficiency, an intra-operative transesophageal echocardiogram (TEE) was performed and a huge free-floating thrombus was detected. Multiple thrombi were removed from the right heart and pulmonary arteries. The patient died after cardiopulmonary bypass support and 12 hours of intensive care. CONCLUSIONS In this case report, we emphasize the importance of the TEE during the preoperational period and during CABG, as well as in the preoperative evaluation of pulmonary hypertension.