Open heart surgery for management of right auricular thrombus related to central venous catheterization

Abstract

Central venous catheters are widely used in critically ill patients; however, they are also associated with increased morbidity and mortality. The literature may underestimate the incidence of catheter-inducible right atrial thrombi that are asymptomatic but potentially life threatening. The recognized risk factors for its development include infections related to the catheter, endothelial injury secondary to mechanical and chemical damage induced by certain medications and infused fluids. The characteristics of the patient and the catheter, such as size, material, type, location and ease of insertion, as well as the duration of placement play an additional role. We report the case of a 38-year-old man, who developed an asymptomatic catheter-inducible right atrial thrombi requiring open heart surgery, after taking a central venous catheter for thirty-five days. The present case highlights existing limitations in making a correct and fast diagnosis, which should be anticipated in patients with multiple risk factors for thrombosis. Given the limited recommendations available, we consider that the most appropriate strategy should be individualized.

Keywords: Calcified right atrial thrombus; Catheter-related thrombosis; Catéter venoso central; Central venous catheter; Extirpación quirúrgica; Surgical removal; Thrombolysis; Trombo auricular derecho calcificado; Trombosis asociada a catéter; Trombólisis.