[Giant Left Atrium Thrombus after Left Atrial Appendectomy:Report of a Case]

Area of Science:

• Cardiology
• Neurology
• Vascular Surgery

Background:

• Atrial fibrillation is a common cause of cardioembolic stroke.
• Left atrial appendage closure is a strategy to prevent stroke in atrial fibrillation patients.
• Giant left atrial thrombus formation can occur despite preventative measures.

Purpose of the Study:

• To investigate the cause of recurrent cerebral infarction in a patient with atrial fibrillation.
• To evaluate the effectiveness of left atrial appendage closure in preventing thrombus formation.
• To describe the management of a giant left atrial thrombus despite anticoagulation and appendage closure.

Main Methods:

• Case report of a 78-year-old female patient.
• Left atrial appendage appendectomy performed for stroke prevention.
• Echocardiogram to assess left atrial size and thrombus.
• Surgical removal of left atrial thrombus and mitral valve replacement.

Main Results:

• A giant left atrial thrombus formed despite left atrial appendage closure and anticoagulation.
• The thrombus was located at the junction of the left pulmonary vein and left atrium, not at the appendage stump.
• Echocardiogram revealed severe spontaneous echo contrast, suggesting significant blood stasis.
• Mitral valve replacement was performed due to suspected restriction of opening.

Conclusions:

• Severe left atrial blood stasis can lead to thrombus formation even after left atrial appendage closure.
• Left atrial appendage closure may not be sufficient to prevent thrombus in all cases of significant left atrial enlargement and stasis.
• Comprehensive management addressing both appendage and overall left atrial environment is crucial for preventing thromboembolism.