139 - Novel Percutaneous Right Ventricular Mural Thrombectomy in a Pediatric Patient: A Case Report

Publication Number: 139.5592

Nandita Shankar, California Northstate University College of Medicine, Elk Grove, CA, United States; James Hill, California North State University school of medicine, El Dorado Hills, CA, United States

Background: Conventional management of intracardiac masses relies on anticoagulant and thrombolytic therapy with surgical excision when indicated. However, some patients may not be eligible for traditional approaches. Catheter-directed aspiration devices offer a potential alternate minimally invasive option. Although aspiration device removal of right heart masses has been reported in adults, there is scant experience in pediatric populations. Notably, right heart mass removal using the AngioVac system in pediatric patients has not been explicitly reported.

Objective: Percutaneous catheter-based thrombectomy using the AngioVac system for removal of a large right ventricle mass in a pediatric patient not eligible for thrombolysis or surgery.

Design/Methods: A previously healthy 12-year old patient hospitalized for pneumonia developed a thrombus in the right ventricle. Transthoracic echocardiogram showed a large mobile mass adherent to the tricuspid apparatus. Rapid enlargement of the thrombus despite therapeutic anticoagulation along with a family history of Factor V Leiden mutation and multiple thromboembolic phenomena indicated need for urgent thrombectomy to avoid risk of a life-threatening pulmonary embolism. The patient’s overall condition and risk for disseminated intravascular coagulation secondary to sepsis made him a poor candidate for surgery or thrombolysis.

Results: Based on institutional experience with the device and the size and location of the thrombus, following multidisciplinary conference and discussion with and consent from the family, the AngioVac system (AngioDynamics, Latham, NY, USA) in a venous-venous configuration was chosen as the best-suited device and procedure for thrombectomy. Complete removal of the mass was achieved as confirmed by transesophageal echocardiogram. The patient tolerated the procedure well with no complications.

Conclusion(s): To our knowledge, this is the first report of successful use of the AngioVac system for percutaneous catheter-based thrombectomy of a large right heart mass in a pediatric patient. Our findings highlight the potential for safe and effective use of the AngioVac system for such purposes in a pediatric population, especially in instances where more traditional approaches may not be feasible.