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Mobile biatrial thrombus in a patient with mitral stenosis under heparin infusion

Kutay Tasdemir1, Bahadir Sarli, Mehmet G Kaya

  • 1Department of Cardiovascular Surgery, Erciyes University School of Medicine, 38039 Kayseri, Turkey. drmgkaya@yahoo.com

Interactive Cardiovascular and Thoracic Surgery
|May 20, 2008
PubMed

Insights

This case report details an extremely rare instance of biatrial thrombus formation in a patient receiving unfractionated heparin. The thrombus likely originated from deep vein thrombosis in the leg, dislodging during treatment.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Hematology

Background:

  • A 58-year-old female presented with acute limb ischemia of the left foot.
  • Cardiovascular examination revealed murmurs, and ECG showed atrial fibrillation with rapid ventricular response.

Observation:

  • Emergent femoro-popliteal embolectomy was performed.
  • Transthoracic echocardiography identified a left atrial thrombus and mild mitral regurgitation.
  • Following unfractionated heparin (UF) infusion, a large right atrial thrombus was detected.

Findings:

  • The patient underwent successful biatrial thrombectomy and mitral valve replacement.
  • Deep vein thrombosis in the left leg was subsequently diagnosed.
  • The right atrial thrombus was hypothesized to have originated from a dislodged piece of calf deep-vein thrombus after heparin initiation.

Implications:

  • This case highlights an exceptionally rare complication of unfractionated heparin therapy.
  • It underscores the importance of comprehensive vascular assessment in patients with atrial fibrillation and embolic events.
  • The findings suggest a potential mechanism for paradoxical embolism from lower extremity deep vein thrombosis to the atria.

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