interventionAL CARDIOLOGY
IMAGE IN CARDIOVASCULAR MEDICINE
Cardiology Journal
2023, Vol. 30, No. 3, 491–492
DOI: 10.5603/CJ.2023.0039
Copyright © 2023 Via Medica
ISSN 1897–5593
eISSN 1898–018X
Percutaneous aspiration of a right atrial thrombus with the AngioVac system
Anna Tyrka12Jakub Stępniewski134Hubert Hymczak25Barbara Szlósarczyk26Monika Komar1Grzegorz Filip7Marcin Waligóra134Piotr Podolec1Rafał Drwiła2Bogusław Kapelak7Grzegorz Kopeć13
1Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
2Department of Anesthesiology and Intensive Care, John Paul II Hospital, Krakow, Poland
3Pulmonary Circulation Center, Jagiellonian University Medical College, Krakow, Poland
4Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland
5Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
6Department of Coronary Artery Disease and Heart Failure, John Paul II Hospital, Krakow, Poland
7Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
Address for correspondence: Grzegorz Kopeć, MD, PhD, Pulmonary Circulation Center, Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, ul. Prądnicka 80, 31–202 Kraków, Poland, tel: +48 500 099 734, fax: +48 12 614 33 32, e-mail: grzegorzkrakow1@gmail.com
Received: 13.12.2023 Accepted: 29.03.2023
This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
The AngioVac (AngioDynamics, USA) is a percutaneous aspiration system designed for removal of pathologic intracardiac structures with the use of large-bore catheter connected to extracorporeal circuit (ECC) filtering and returning blood.
A 46-year-old male was hospitalized due to myocardial infarction with ST segment elevation. This was complicated by mitral and aortic valve insufficiencies and refractory cardiogenic shock requiring urgent replacement of both valves in two separate surgical interventions and prolonged use of veno-arterial-extracorporeal-membrane- -oxygenation. Follow-up echocardiography revealed a mobile structure in the right atrium (RA) of 4.5 × 1.5 cm resistant to anticoagulation (Fig. 1). A multi-specialty team agreed to utilize a percutaneous approach as surgical removal was deemed as too high-risk. The procedure was performed under fluoro- and transesophageal echocardiography (TEE) guidance and general anesthesia. The 22 French (Fr) AngioVac 180° angled cannula was introduced to the RA through a 26 Fr left femoral vein (FV) sheath, and connected to ECC to aspirate the clot and to return the blood through an 18 Fr reinfusion sheath to the right FV. FVs were chosen as jugular veins were occupied and the thrombus location near fossa ovalis made femoral access more suitable. Initiation of the ECC resulted in a rapid thrombus removal seen in TEE and safe procedure completion. The patient was extubated on the same day and started rehabilitation.
Figure 1. A. A transesophageal echocardiography (TEE) showing a mobile structure (arrow) in the right atrium (RA) of 4.5 × 1.5 cm in size posing a risk for pulmonary artery embolization; B. An expandable funnel-shaped distal tip of the AngioVac Cannula (arrow) aspirating the RA structure (*) with the suction forces generated by the extracorporeal circulation; C. The TEE showing the free from mobile structure RA; D. The 22 French (Fr) AngioVac 180° angled Cannula with an expandable funnel-shaped distal tip; E. Fluoroscopy showing the introduction of the AngioVac Cannula (arrow) to the RA structure through a 26 Fr left femoral vein sheath and a stiff wire; F. An extracorporeal circulation filter showing removed thrombus.
It was shown herein, that removal of an intracardiac structure with the use of AngioVac system was feasible and safe. This minimally invasive procedure may be an option for patients who are not candidates for an open heart surgery.
The authors would like to acknowledge Krzysztof Szymański, Bogumiła Rachwał — specialists of extracorporeal circulation, Monika Kurek, Szymon Trzaskoś, Elżbieta Skupień-Schneider — nurses and instrumentation, Adam Baluszek — technician, for their dedication to perform the procedure.
This article was supported by the science fund of the John Paul II Hospital, Krakow, Poland (no. FN4/2023 to J.S.).
