Right atrial thrombus and pulmonary embolism one year after ventricular septal defect patch repair: successful surgical management of a complicated case.
Elshaer O, Gomaa M, et al. • Journal of cardiothoracic surgery • 2026
A 17-year-old male developed a massive right atrial thrombus with pulmonary embolism one year after surgical VSD repair in the absence of any known hypercoagulable state, requiring urgent surgical excision and pulmonary embolectomy.
Key Findings
Background
A massive right atrial thrombus with concurrent pulmonary embolism developed one year after surgical ventricular septal defect patch repair in a young patient with no known hypercoagulable state.
The patient was a 17-year-old male with a history of surgical VSD repair one year prior to presentation.
The patient was not taking any antithrombotic therapy prior to presentation.
No known hypercoagulable state was identified.
This represents a rare late thromboembolic complication of VSD repair, occurring well outside the typical immediate postoperative period.
Results
The patient presented with acute dyspnea, tachycardia, and severe hypoxia, with imaging confirming a large freely mobile right atrial mass and massive right pulmonary artery embolus.
Presenting symptoms included acute dyspnea, tachycardia, and severe hypoxia.
Transthoracic echocardiography revealed a large, freely mobile right atrial mass.
CT pulmonary angiography confirmed a massive right pulmonary artery embolus.
Cardiac magnetic resonance imaging characterized the right atrial mass as an intracardiac thrombus.
Results
Clinical deterioration despite therapeutic anticoagulation necessitated urgent surgical intervention consisting of right atrial mass excision and pulmonary embolectomy.
The patient deteriorated despite being placed on therapeutic anticoagulation.
Urgent cardiac surgery was performed, including right atrial mass excision and pulmonary embolectomy.
The surgical intervention was described as successful.
Postoperative histopathology confirmed the excised mass to be a thrombus.
Background
Right heart thrombi are characterized as rare but life-threatening, with particularly high mortality when accompanied by pulmonary embolism.
The authors describe right heart thrombi as 'rare but life-threatening.'
Mortality is described as 'particularly high' when right heart thrombus is accompanied by pulmonary embolism.
Cardiac surgery may predispose to in-situ thrombus formation via suture lines or patch material.
Thromboembolic risk and preventive strategies following VSD repair are noted to remain unclear.
Conclusions
The authors identify a gap in evidence regarding post-VSD closure surveillance and thromboprophylaxis strategies, calling for further research.
The authors state that 'further research is needed to clarify post-VSD closure surveillance and thromboprophylaxis strategies.'
The case highlights that late right atrial thrombus can occur up to one year or more after surgical VSD repair.
The absence of antithrombotic therapy at the time of presentation raises questions about the need for longer-term thromboprophylaxis following VSD patch repair.
What This Means
This research describes a rare and serious complication in a 17-year-old boy who had undergone surgery to repair a hole in his heart (ventricular septal defect, or VSD) one year earlier. Despite having no known blood-clotting disorder and not taking any blood thinners after his initial surgery, he developed a large blood clot inside his right atrium (one of the heart's chambers) that also caused a dangerous blockage in his lung arteries (pulmonary embolism). He arrived at the hospital with severe breathing difficulty and low oxygen levels, and imaging tests confirmed both the heart clot and the lung blockage. When blood-thinning medications alone did not stabilize his condition, surgeons successfully removed the clot from his heart and cleared the blockage in his lungs. Lab analysis afterward confirmed the mass was indeed a blood clot, likely related to the patch material or suture lines from his prior heart surgery.
This case matters because it shows that patients who undergo surgical repair of heart defects using patch material may face a risk of forming blood clots long after the operation — in this case, a full year later. Currently, there are no clear guidelines on how long patients should be monitored after VSD repair or whether they should receive preventive blood-thinning treatment. This research suggests that the medical community may need to reconsider follow-up care and possible thromboprophylaxis (clot-prevention strategies) for patients after VSD patch surgery, even when they appear to be recovering normally and have no obvious risk factors for clotting.
Elshaer O, Gomaa M, Abdelfattah M, Salama M, Hammad M. (2026). Right atrial thrombus and pulmonary embolism one year after ventricular septal defect patch repair: successful surgical management of a complicated case.. Journal of cardiothoracic surgery. https://doi.org/10.1186/s13019-026-04582-z