Multiple embolisations in rheumatic heart disease: a case report

Though systemic thromboembolism is not an infrequent complication of rheumatic valvular disease, multiple embolic phenomena are rare.

To present a patient with rheumatic heart disease associated with multiple embolic complications.

A 44-year-old lady with rheumatic valvular disease and atrial fibrillation defaulted anticoagulant medication, and subsequently presented with acute chest pain, acute left ventricular failure, focal neurological deficit and gangrenous lower limb extremities. Electrocardiography showed atrial fibrillation and an old anteroseptal myocardial infarction. Echocardiography showed multiple valvular lesions and multiple thrombi in the left atrium. Computed tomogram scan demonstrated a large infarct involving the region supplied by the right middle cerebral artery. Bilateral above knee amputation was performed. Recovery from neurological deficit was complete. She had, during a 4-year follow-up and anticoagulation remained free of new clinically evident embolic complications. Serial echocardiography however showed that the atrial clots had persisted and presumably fibrosed.

Multiple systemic thromboembolisms are serious complication of atrial fibrillation of valvular aetiology, and their prevention requires continuous anticoagulation.