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Giant Thrombus Formation Immediately After Mitral Valvuloplasty
Yoshihiro Aizawa1, Toshiko Nakai, Takafumi Kurosawa
1Division of Cardiology, Department of Medicine, Nihon University School of Medicine.
International Heart Journal
|November 10, 2015
Summary
Patients with atrial fibrillation (AF) face cardioembolism risk. A case highlights sudden giant thrombus formation post-surgery, emphasizing vigilant monitoring and anticoagulation, even without pre-operative signs.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Thrombosis Research
Background:
- Atrial fibrillation (AF) patients have a high risk of cardioembolism.
- Left atrial appendage (LAA) thrombus formation is common in AF, necessitating detection via transesophageal echocardiography (TEE).
- LAA closure during mitral valve surgery aims to prevent stroke in AF patients.
Observation:
- A 65-year-old woman with severe mitral regurgitation (MR) and AF developed a giant left atrial thrombus 7 days post-mitral and tricuspid valvuloplasty with LAA resection.
- Pre-operative TEE revealed no atrial thrombus or spontaneous echo contrast (SEC).
Findings:
- A giant intramural thrombus formed rapidly in the left atrium post-operatively.
- Post-surgical atrial dysfunction and altered left atrial morphology in severe MR with AF and heart failure created a pro-thrombotic state.
Implications:
- This case underscores the need for continuous perioperative surveillance for thrombus formation in AF patients.
- Maintaining anticoagulation is crucial throughout the perioperative period, irrespective of pre-operative TEE findings.
- Aggressive anticoagulation management is vital even when no pre-operative thrombus or SEC is detected.
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