Every great story seems to begin with a snake: a case report of a huge right atrial thrombus during transcatheter mitral valve repair

Background: TEER has revolutionized mitral regurgitation treatment, addressing clinical burden in aging patients. However, thrombotic complications may still occur. Case presentation: An 83-year-old man with severe mitral regurgitation underwent a MitraClip procedure. A huge molding thrombus was observed during the procedure. To prevent cerebral embolization, two carotid filters were placed. The procedure was successfully ended, and mitral regurgitation was reduced. The patient was stable during the procedure, with no evidence of pulmonary or cerebral embolism. Conclusions: 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.