Transesophageal Echocardiography Aids the Surgical Decision-Making and the Surgical Process in a Rare Case of Ascending Aorta Thrombus: A Case Report

Abstract

Abstract Background Embolizing ascending aortic thrombus is a rarely reported condition. Treatment of aortic thrombus remains controversial. Transesophageal echocardiogram (TEE) is widely acknowledged as an excellent diagnostic tool in the evaluation of aortic mass. Case Presentation We report a 61-year-old male patient presented to us with right-sided back pain accompanied with numbness in right arm for 12 hours and a history of poorly controlled hypertension and heavy smoking. Computed tomography angiography of the aorta showed filling defect in the ascending aorta. A heparin drip was initiated and emergency surgical removal was performed under cardiopulmonary bypass with the probable diagnosis of ascending aorta thrombus. TEE was performed upon general anesthesia, and confirmed irregular and mobile mass in the ascending aorta. In addition, TEE guided aortic cannulation and facilitated the surgical team to better understand the location of the thrombus. The thrombus was removed with a minimal incision. The recovery of this patient was complicated with thromboembolic events and he was finally discharged with satisfactory recovery after 56 days of hospital stay. Conclusion Embolizing ascending aortic thrombus is a rare and dangerous condition. TEE as a real-time imaging tool helps understand the nature and the location of the embolizing entity during treatment plan making and during surgical process.