An Unusual Case of Left Atrial Mural Thrombus following Aortic Valve Replacement.
Mohamed E TahaAmmar EljackHisham IbrahimChanwit RoongsritongPublished in: Case reports in cardiology (2019)
The left atrial thrombus is a well-known complication of atrial fibrillation and rheumatic mitral valve disease and carries a high risk for systemic thromboembolism. They are generally dissolved after a certain period of optimal anticoagulation. A large thrombus, on the other hand, may persist even with adequate anticoagulation. The surgical removal of a thrombus theoretically poses some risk of systemic embolization, making its management a clinical dilemma. Furthermore, a refractory thrombus is uncommon. Thus, an evidence-based guideline in selecting the optimal therapy is needed. We report a case of a 74-year-old male with atrial fibrillation and a history of unprovoked pulmonary embolism who was incidentally found to have a massive left atrial thrombus shortly after discontinuing warfarin about 4 months following bioprosthetic aortic valve replacement. The thrombus was refractory to anticoagulation posing a clinical management dilemma. This case is interesting in terms of presentation and the approach to diagnosis and treatment.
Keyphrases
- left atrial
- atrial fibrillation
- aortic valve replacement
- mitral valve
- catheter ablation
- oral anticoagulants
- pulmonary embolism
- direct oral anticoagulants
- aortic valve
- transcatheter aortic valve implantation
- left atrial appendage
- aortic stenosis
- left ventricular
- venous thromboembolism
- heart failure
- percutaneous coronary intervention
- ejection fraction
- acute coronary syndrome