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[Multiple systemic embolization from floating thrombus in left atrium]
S Fukuda1, Y Wanibuchi, M Nishimi
1Division of Surgery, Mitsui Memorial Hospital, Cardiovascular Center, Tokyo, Japan.
Insights
A patient with mitral valve stenosis had a left atrial thrombus that caused multiple organ infarctions. This case highlights the potential for even weakly attached thrombi to embolize, leading to severe complications like stroke and heart attack.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Mitral valve stenosis can lead to thrombus formation in the left atrium.
- Embolization of left atrial thrombi can cause systemic infarction, including cerebral, myocardial, and renal events.
Observation:
- A 66-year-old woman presented with multiple infarcts secondary to an unusual left atrial thrombus.
- The thrombus was noted to be attached by only thin, fragile strands, suggesting a high risk of embolization.
Findings:
- The patient underwent successful emergency mitral valve replacement and thrombectomy.
- The easily removable thrombus was hypothesized to be a precursor to a free-floating ball thrombus without a stalk.
Implications:
- This case underscores the critical importance of early detection and intervention for left atrial thrombi, even those with seemingly tenuous attachments.
- Understanding thrombus morphology and attachment is crucial for predicting embolic risk in valvular heart disease.
- Prompt surgical management can prevent catastrophic embolic events in patients with mitral valve stenosis and intracardiac thrombi.
Abstract:
A 66-year-old woman was referred to our hospital because of cerebral infarction, myocardial infarction and renal infarction. Further examination indicated that she was suffering from mitral valve stenosis with a floating thrombus in the left atrium. She underwent emergency mitral valve replacement and thrombectomy. The thrombus was attached to the left atrium by only four thin and weak strings and removed easily. We think that the thrombus was the precursor of a free-floating ball thrombus without stalk.