48-year-old female presented with dyspnea and fatigue in June 2020. CT imaging found pulmonary embolus and a heparin drip was initiated. She later developed chest pain which led to an echocardiogram. This imaging noted biatrial thrombus extending through mitral and tricuspid valve, as well as through a patent foramen ovale (PFO) (Fig. 1, 2). She underwent emergent sternotomy, left and right atrial embolectomy, left and right pulmonary embolectomy, and atrial septal defect closure (Fig. 3). She progressed well post op and was discharged on postoperative day 7 on therapeutic anticoagulation. Remains in good condition on follow up on long term follow up.