# Every great story seems to begin with a snake: a case report of large right atrial thrombus encountered during MitraClip procedure

## TL;DR

This case report describes a large heart clot found during a MitraClip procedure and emphasizes the need for careful management and research into clot prevention.

## Contribution

The case highlights the unexpected occurrence of a large thrombus during TEER and the use of cerebral protection devices.

## Key findings

- A large right atrial thrombus was encountered during a MitraClip procedure in an 83-year-old patient.
- The use of carotid filters helped prevent cerebral embolization during the procedure.
- The procedure was completed successfully with no evidence of embolism.

## Abstract

TEER has revolutionized mitral regurgitation treatment, addressing clinical burden in aging patients. However, thrombotic complications may still occur.

An 83-year-old man with severe mitral regurgitation underwent a MitraClip procedure. A large molding thrombus was observed during the procedure, despite a targeted ACT. To prevent cerebral embolization, two carotid filters were placed. The procedure was successfully completed, and mitral regurgitation was reduced. The patient was stable during the procedure, with no evidence of pulmonary or cerebral embolism.

The case highlights the importance of close observation and multidisciplinary decision-making in managing acute thrombus during TEER. Further research is needed to establish the potential role of cerebral protection devices and the effect of anticoagulation procedures on thrombus formation.

The online version contains supplementary material available at 10.1186/s43044-025-00661-z.