Management of left atrial endocardium after extensive thrombectomy

Area of Science:

• Cardiovascular Surgery
• Cardiac Pathology
• Thrombosis Research

Background:

• Left atrial thrombosis is common in patients with chronic mitral valve disease and atrial fibrillation.
• Organized thrombus in chronic cases presents surgical challenges due to dense adhesions and difficulty in achieving clean cleavage planes.
• Residual thrombotic material or endocardial damage post-thrombectomy can lead to recurrent thrombosis and thromboembolism.

Observation:

• A patient with chronic mitral valve disease and atrial fibrillation presented with organized left atrial thrombus.
• Standard thrombectomy was deemed challenging due to the organized nature and adhesions of the thrombus.
• The surgical team opted for an extensive thrombectomy followed by reconstruction.

Findings:

• Successful and extensive thrombectomy was performed.
• The endocardial surface was covered using a fresh autologous pericardial patch.
• This approach addressed the challenges of residual material and endocardial damage.

Implications:

• This technique offers a viable solution for managing complex, organized left atrial thrombus during cardiac surgery.
• Utilizing autologous pericardium for endocardial coverage may reduce the risk of recurrent thrombosis and thromboembolic events.
• This approach could improve outcomes for patients undergoing surgery for chronic mitral valve disease with associated atrial thrombosis.