title: Giant Thrombus Formation Immediately After Mitral Valvuloplasty.
abstract: Patients with atrial fibrillation (AF) are at risk of cardioembolism.(1,2)) Atrial thrombus formation associated with AF typically occurs in the left atrial appendage (LAA);(3)) therefore, transesophageal echocardiography (TEE) is important for detection of such a thrombus and measurement of LAA flow velocity.(4,5)) LAA closure is routinely performed during mitral valve surgery in patients with AF to prevent cardiogenic stroke.(6)) We report the case of a 65-year-old woman with severe mitral regurgitation (MR) and AF in whom a giant thrombus formed almost immediately after mitral and tricuspid valvuloplasty and concurrent LAA resection. No atrial thrombus or spontaneous echo contrast (SEC) was detected by TEE before the surgery. However, a giant intramural thrombus was detected in the left atrium 7 days after surgery. It was thought that the atrial dysfunction as well as the change in morphology of the left atrium resulting from the severe MR complicated by AF and congestive heart failure produced a thrombotic substrate. This case suggests that careful surveillance for thrombus formation and careful maintenance of anticoagulation therapy are needed throughout the perioperative period even if no SEC or thrombus is detected before surgery.
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Aizawa
authors.forename: Toshiko
authors.initials: T
authors.lastname: Nakai
authors.forename: Takafumi
authors.initials: T
authors.lastname: Kurosawa
authors.forename: Yuki
authors.initials: Y
authors.lastname: Saito
authors.forename: Koyuru
authors.initials: K
authors.lastname: Monno
authors.forename: Takumi
authors.initials: T
authors.lastname: Hatta
authors.forename: Takafumi
authors.initials: T
authors.lastname: Hiro
authors.forename: Munehito
authors.initials: M
authors.lastname: Arimoto
authors.forename: Shunji
authors.initials: S
authors.lastname: Osaka
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Hata
authors.forename: Motomi
authors.initials: M
authors.lastname: Shiono
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirayama
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D020517:Atrial Appendage / Q000000981:diagnostic imaging*; D001281:Atrial Fibrillation / Q000150:complications*; D016903:Drug Monitoring; D017548:Echocardiography, Transesophageal / Q000379:methods; D006801:Humans; D008297:Male; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects* / Q000379:methods; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy; D013927:Thrombosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin