case_images: PMC11718386_01
case_images: Transthoracic echocardiography, parasternal short axis view: (A) Right heart dilatation with characteristic D-shape of the left ventricle and (B) arrow indicates clot formation in the right atrium.
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case_images: Upon admission, transthoracic echocardiography (TTE) revealed right heart dilatation with the characteristic D-shape of the left ventricle in the short axis view (Figure 1A). This was supported by a large clot formation seen in the right atrium (Figure 1B, Supplementary material online, Video S1).
case_images: Computed tomography scan shows a large clot in the right pulmonary artery with (arrow).
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case_images: CT scan confirmed bilateral PE, while there were central thrombus formations on the right side and on the left side a rather thread-like PE (Figure 2), laboratory tests showed elevated cardiac troponin (349 ng/mL) and NT-proBNP (4101 pg/mL) levels.
case_images: (A) Insertion of both large bore venous sheaths (21 F for the venous extracorporeal membrane oxygenation cannula and 24 F for the thrombectomy device) into the right femoral vein. The arterial cannula is placed in the left femoral artery and (B) two separate Z-shaped sutures were used to close the venous access and Perclose ProGlide (Abbott) for hemostasis of the left femoral artery.
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case_images: After the implementation of VA-ECMO flow, we inserted a second sheath (Inari Intri24; 24 F) into the right femoral vein (Figure 3A) and carefully advanced a pigtail catheter to the right pulmonary artery. Perclose ProStyle (Abbott) was used to achieve hemostasis of the right femoral artery as depicted in Figure 3B.
case_images: Angiographic visualization of large clots in the right pulmonary artery (arrow).
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case_images: After angiography with visualization of large clots in the right pulmonary artery (Figure 4), we advanced the 24 F aspiration catheter to the clot formation and were able to retrieve large amounts of white clots (Figure 5).
case_images: White clots aspirated from the right pulmonary artery.
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case_images: After angiography with visualization of large clots in the right pulmonary artery (Figure 4), we advanced the 24 F aspiration catheter to the clot formation and were able to retrieve large amounts of white clots (Figure 5).