28: From Crisis to Control: Managing Right Heart Chamber Thrombus with the Temporary IVC Filter on Patient with VA-ECMO: A Case Report

Introduction: Pulmonary embolism (PE) is a significant complication in critically ill patients that often requires immediate intervention, particularly in cases with contraindications to anticoagulation or where thrombolysis has been ineffective. The Angel® catheter, a novel inferior vena cava (IVC) filter integrated with a central venous catheter, provides a potential solution for preventing and managing PE (3). This report presents a successful removal of a thrombus from the right heart chamber using the temporary IVC filter. Case Report: A 52-year-old previously healthy male presented to the emergency room following a syncopal episode. Initial assessment revealed bilateral PE, confirmed by CT angiography, and echocardiography indicated right ventricular dilation. Despite the initiation of heart failure treatment, the patient experienced multiple cardiac arrests, necessitating ECPR and urgent thrombolysis, which proved ineffective. Subsequently, the patient underwent an urgent bilateral pulmonary embolectomy using a mechanical thrombectomy device and was placed on VA-ECMO for hemodynamic support. His condition stabilized, with adequate urine output and improving liver enzyme levels. However, a transesophageal echocardiogram (TEE) revealed a floating thrombus in the right ventricle, prompting further interventions. The patient was urgently transferred to the catheterization lab, where the thrombus was successfully removed using the IVC filter catheter. Results: The patient was decannulated from VA ECMO and extubated from mechanical ventilation following the procedure. As his condition improved, he was eventually discharged from the intensive care unit. These findings are limited to a single patient, which may hinder generalization. Potential complications related to catheter placement and thrombus manipulation necessitate careful evaluation. Conclusion: This case illustrates the successful use of a temporary IVC filter for the aspiration of a PE from the right heart chamber with unsuccessful thrombolysis. The device provides a promising option for managing PE while facilitating safe bedside procedures. Further studies are warranted to explore its efficacy and safety.