Left Atrial Ball-Shaped Thrombus with Concomitant Biatrial Appendage Thrombi in a Patient with Prior Mitral Valve...

Area of Science:

• Cardiology
• Cardiovascular Imaging

Background:

• Mitral valve replacement surgery can predispose patients to atrial thrombus formation.
• Therapeutic anticoagulation is standard for patients with mechanical heart valves.
• Intractable bleeding can necessitate the discontinuation of anticoagulation therapy.

Observation:

• A 67-year-old woman with a history of mitral valve replacement presented with three large atrial thrombi discovered incidentally.
• These thrombi included a free-floating ball-shaped left atrial thrombus, a left atrial appendage thrombus, and a right atrial appendage thrombus.
• The patient had discontinued anticoagulation for several months due to severe gastrointestinal bleeding.

Findings:

• Transesophageal echocardiography confirmed the presence of multiple large atrial thrombi.
• Despite resuming adequate anticoagulation for one month, the free-floating left atrial thrombus remained.
• The coexistence of a free-floating ball-shaped thrombus with appendage thrombi is exceptionally rare.

Implications:

• This case highlights the complex management challenges in patients with mechanical heart valves requiring anticoagulation but experiencing bleeding.
• The persistence of a free-floating thrombus despite anticoagulation warrants further investigation into its embolic potential and optimal treatment strategies.
• The rare echocardiographic finding underscores the importance of comprehensive cardiac imaging in evaluating atrial thrombi in high-risk patients.