Right atrial thrombosis and pulmonary embolism after atrial septal defect repair: could it be hereditary thrombophilia?

We read with interest the case report by Gonzalez-Calle et al. on ‘Right atrial thrombosis and pulmonary embolism after atrial septal defect repair’ [1]. Manlhiot et al. reported several factors that predispose to thrombosis after paediatric cardiac surgery. The factors that the authors suspected—tranexamic acid or foreign object—are also listed there [2]. Probably, according to the patient’s clinical course, the most acceptable reason was a foreign object, but we cannot rule out concomitant or primary hereditary thrombophilia. We think that the haematological screening performed for this patient (proteins C and S and genetic [prothrombin gene] tests) were insufficient to diagnose thrombophilia. The haematological assessment should also encompass antiphospholipid antibodies, factor V Leiden, activated protein C resistance, lupus anticoagulant, antithrombin III, fibrinogen, homocystein level and Factors II, VII, VIII and IX [3]. Perhaps the main cause of the right atrial thrombosis was hereditary thrombophilia, which was overlooked.