2025, Vol. 8, Issue 4, Part B

Right atrial thrombus (RAT) is an uncommon but potentially fatal complication following cardiac surgery. Prompt recognition and early intervention are crucial for patient survival.
We report a 67-year-old female with chronic kidney disease (CKD) on maintenance hemodialysis, who underwent coronary artery bypass grafting (CABG) for incidentally diagnosed triple vessel disease during pre-renal transplant evaluation. Her postoperative course was complicated by heparin induced thrombocytopenia (HIT), hemodynamic instability, and subsequent echocardiography revealed a right atrial thrombus. Mechanical thrombectomy using the Penumbra device was performed with successful hemodynamic recovery. This case highlights the importance of high clinical suspicion and rapid intervention in postoperative cardiac patients presenting with unexplained hypotension and hypoxia. Mechanical thrombectomy can be a life-saving option in selected patients.