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Trombo auricular izquierdo en estenosis mitral reumática: un caso de fracaso terapéutico de la proporción normalizada
Muhammad Salman Sabri1, Carly Weber2, Yanis Belkadi3
1Department of Internal Medicine, Jefferson Abington Hospital, Abington, Pennsylvania, USA.
JACC. Case reports
|September 5, 2025
Resumen
Los pacientes con estenosis mitral reumática y flutter auricular se enfrentan a un alto riesgo de trombo del apéndice auricular izquierdo, incluso con anticoagulación. El ecocardiograma transesofágico es crucial antes de la cardioversión para detectar trombos en estos individuos de alto riesgo.
Área de la Ciencia:
- Cardiología
- Electrofisiología cardíaca
- Imágenes médicas
Sus antecedentes:
- La estenosis mitral reumática (EM) está asociada con un mayor riesgo de trombo del apéndice auricular izquierdo (LAA), especialmente en pacientes con fibrilación auricular o flutter.
- La anticoagulación terapéutica no siempre puede prevenir la formación de trombos de LAA en esta población de pacientes.
- El trombo auricular izquierdo (LA) plantea un riesgo significativo de eventos embolicos.
Objetivo del estudio:
- Para resaltar el aumento del riesgo de trombo LAA en pacientes con EM reumática y flutter auricular.
- Para enfatizar la importancia del ecocardiograma transesofágico (TEE) antes de la cardioversión en este grupo específico de pacientes.
- Discutir las estrategias de manejo del trombo LAA en el contexto de la EM reumática.
Principales métodos:
- Presentación del caso de una mujer de 72 años con esclerosis múltiple moderada y aleteo auricular que se presenta con disnea.
- La evaluación diagnóstica incluyó un ecocardiograma transesofágico (TEE) para evaluar el trombo de LAA.
- El tratamiento consistió en ajustar los objetivos de anticoagulación y aplazar la cardioversión.
Principales resultados:
- En un paciente con EM reumática y flutter auricular se identificó un gran trombo de LAA en el TEE, a pesar de una relación normalizada internacional (INR) > 2,5.
- La cardioversión se aplazó debido a la presencia de trombos de LAA.
- El objetivo terapéutico de la INR se incrementó a 2,5-3,5.
Conclusiones:
- Los pacientes con esclerosis múltiple reumática y flutter auricular concurrente están en alto riesgo de LAA y trombo LA, lo que requiere TEE antes de la cardioversión.
- Las decisiones de cardioversión en pacientes con EM reumática deben guiarse por los hallazgos de TEE para mitigar el riesgo de embolia.
- Se requiere más investigación para determinar el manejo óptimo, incluida la intervención quirúrgica, para el trombo LAA en la EM reumática.
Palabras clave:
Fibrilación auricularTremor en las aurículasCardioversiónTrombo del apéndice auricular izquierdoEstenosis reumática de la mitralecocardiograma transesofágicoMás Videos Relacionados
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