Mahender K. Gaba, MD; Prakriti Gaba, MD; John M. Luber, MD
A man in his mid-50s presents with progressively worsening, sharp, nonradiating chest pain and concomitant exertional shortness of breath, dry cough, and lightheadedness. His medical history is significant for pulmonary embolism. Imaging shows evidence of right heart strain, an occlusive pulmonary embolism of the left main pulmonary artery, and several peripheral consolidations in the left lower lung field consistent with infarction. He began anticoagulation therapy with intravenous heparin, and an echocardiogram shows bowing of the interventricular septum into the left ventricle and a very large, mobile, nonhomogeneous, pedunculated mass straddling the tricuspid valve and moving between the right atrium and right ventricle. What would you do next?