Evacuation of a Large Intracardiac Thrombus at Cavoatrial Junction Using a Coaxial Aspiration System Through an ŌNŌ Retrieval Device in a Pediatric Patient

Intracardiac thrombus in the right heart has a great risk of embolizing to the pulmonary circulation leading to great morbidity and mortality. Removal of large thrombi incurs an increased risk of embolization, especially if the clot is more acute and not fully adherent. We present a case of transcatheter removal of a thrombus at the right atrial and superior vena cava (RA-SVC) junction using a novel technique in a patient with transfusion-dependent Fanconi anemia status, bone marrow transplant, and steroid-resistant graft-versus-host disease using a coaxial system of a Penumbra Thrombectomy catheter with a ŌNŌ Retrieval Device. Systemic anticoagulation or thrombolysis may be ineffective in treating large and organized thrombi, and most surgical management techniques require cardiopulmonary bypass in these often fragile patients. The combined use of multiple intravascular techniques to stabilize and extract the thrombus can be utilized in unstable patients when the threat of pulmonary embolism is high. Critically ill and unstable patients with large, complex, and organized thrombi can benefit from the use of the presented novel, efficient, and safe approach, guarding against thrombus embolization during thrombectomy.