[Huge Left Thrombosis after Mitral Valvuloplasty and Maze Procedure;Report of a Case]

Area of Science:

• Cardiology
• Cardiac Surgery
• Thrombosis Research

Background:

• Mitral valvuloplasty is a common procedure for mitral valve regurgitation.
• Anticoagulation is typically not required for patients in sinus rhythm post-procedure.
• Atrial fibrillation management often involves procedures like the maze procedure.

Observation:

• A 66-year-old woman developed left atrial thrombosis 4 years after mitral valvuloplasty and maze procedure.
• The patient maintained sinus rhythm, challenging the standard post-procedure care guidelines.
• Echocardiography revealed a narrow mitral valve area, absent A wave, and a significantly enlarged left atrium.

Findings:

• Left atrial thrombosis was present despite the absence of atrial fibrillation.
• The thrombus was large and attached to the left atrial wall, independent of the maze procedure ablation lines.
• These findings suggest that factors beyond rhythm status, such as left atrial size and valve condition, are critical.

Implications:

• Patients with large left atria or rheumatic mitral valves post-valvuloplasty require vigilant monitoring, including echocardiography.
• Consideration of anticoagulation therapy may be warranted in these high-risk patients, irrespective of sinus rhythm maintenance.
• This case underscores the complexity of thromboembolic risk assessment after mitral valve interventions.