Caught red-handed: role of 3D echocardiography

A 65-year-old man was admitted to the cardiac surgery department with massive pulmonary embolism and severe right ventricular failure.The patient did not present any symptoms that could suggest ischemia of the central nervous system or peripheral embolism, except for those related to pulmonary circulation.Transesophageal echocardiography revealed a mobile, ballooning structure with the morphology of a thrombus in the right atrium, passing through the patent foramen ovale into the left atrium (Figure 1A,B).The structure in both the right and left atria was approximately 40 mm in length.Thanks to the use of three-dimensional echocardiography, especially photorealistic imaging, it was possible to accurately assess the morphology of the structure (Figure 1 C,D) [1,2].The thrombus was removed from the fossa ovalis region (Figure 1 E,F).By comparing the removed thrombus with the preoperative 3D echocardiographic image, we ensured that the thrombus was completely removed.In addition, surgical thrombectomy of massive thrombi in the right and left pulmonary arteries was performed.After extracorporeal circulation, a significant improvement in right ventricular contractility was observed, and no additional structures were observed in the heart chambers.