Journal of Heart and Cardiology - ommegaonline.org [1]Thrombi in LA occur nearly in 17% of patients...
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Journal of Heart and Cardiology Case Report Open Access Suma M. Victor*, Ramkumar S, Ezhilan J J Heart Cardiol | Volume 3: Issue 2 Case Report A 55 year old lady, known to have RHD, underwent closed mitral valvotomy 15 years back, presented with palpitations and worsening dyspnoea. She had not been on any medication for past 10 years. Her ECG showed atrial fibrillation with fast ventricular rate. The chest roentgenogram demonstrated severe pulmonary hypertension with enlarged LA. Transthoracic echocardiography established a diagnosis of severe mitral restenosis (0.6 cm 2 ) and revealed hugely dilated LA with multiple thrombi (Figure 1), the largest measuring 3.3 cm x 3.9 cm, close to the roof and septum with no obvious attachment (Figure 2). Two more thrombi are seen attached to the floor of LA and another thrombus in the appendage. Patient was stabilized with medication and underwent successful mitral valve replacement surgery with LA clot removal and LA appendage exclusion. Post operatively she had an uneventful course and asymptomatic on follow-up. (“Supplementary: movie clips”) Figure 1: Hugely dilated LA with multiple thrombi. Multiple Giant Left Atrial Thrombi in Mitral Stenosis Copy rights: © 2017 Suma M. Victor. This is an Open access article distributed under the terms of Creative Com- mons Attribution 4.0 International License. 31 *Corresponding author: Suma M. Victor, DNB., Institute of Cardiovascular Diseases, Madras Medical Mission, 4A, J.J. Nagar, Mogappair, Chennai – 600 037, India, Tel: 91 44 26565961; Fax: 91 44 26565859; E-mail: [email protected] Senior consultant cardiologist, Madras medical mission, Chennai. India Abstract Rheumatic Heart Disease (RHD) is rarely seen in developed countries but still is a common cause of Mitral valve Stenosis (MS) in the developing world. This case demonstrates unusual echocardiographic images of multiple giant Left Atrial (LA) thrombi as a consequence of chronic severe MS. Received Date: November 23, 2016 Accepted Date: May 24, 2017 Published Date: May 26, 2017 Citation: Suma M. Victor, et al. Multiple Giant Left Atrial Thrombi in Mitral Stenosis. (2017) J Heart Cardiol 3(2): 31- 32. DOI: 10.15436/2378-6914.17.1226 Suma M. Victor, et al.
Transcript of Journal of Heart and Cardiology - ommegaonline.org [1]Thrombi in LA occur nearly in 17% of patients...
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Journal of Heart and Cardiology
Case Report Open Access
Suma M. Victor*, Ramkumar S, Ezhilan J
J Heart Cardiol | Volume 3: Issue 2
Case Report
A 55 year old lady, known to have RHD, underwent closed mitral valvotomy 15 years back, presented with palpitations and worsening dyspnoea. She had not been on any medication for past 10 years. Her ECG showed atrial fibrillation with fast ventricular rate. The chest roentgenogram demonstrated severe pulmonary hypertension with enlarged LA. Transthoracic echocardiography established a diagnosis of severe mitral restenosis (0.6 cm2) and revealed hugely dilated LA with multiple thrombi (Figure 1), the largest measuring 3.3 cm x 3.9 cm, close to the roof and septum with no obvious attachment (Figure 2). Two more thrombi are seen attached to the floor of LA and another thrombus in the appendage. Patient was stabilized with medication and underwent successful mitral valve replacement surgery with LA clot removal and LA appendage exclusion. Post operatively she had an uneventful course and asymptomatic on follow-up. (“Supplementary: movie clips”)
Figure 1: Hugely dilated LA with multiple thrombi.
Multiple Giant Left Atrial Thrombi in Mitral Stenosis
Copy rights: © 2017 Suma M. Victor. This is an Open access article distributed under the terms of Creative Com-mons Attribution 4.0 International License.
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*Corresponding author: Suma M. Victor, DNB., Institute of Cardiovascular Diseases, Madras Medical Mission, 4A, J.J. Nagar, Mogappair, Chennai – 600 037, India, Tel: 91 44 26565961; Fax: 91 44 26565859; E-mail: [email protected]
Senior consultant cardiologist, Madras medical mission, Chennai. India
Abstract Rheumatic Heart Disease (RHD) is rarely seen in developed countries but still is a common cause of Mitral valve Stenosis (MS) in the developing world. This case demonstrates unusual echocardiographic images of multiple giant Left Atrial (LA) thrombi as a consequence of chronic severe MS.
Received Date: November 23, 2016Accepted Date: May 24, 2017Published Date: May 26, 2017
Citation: Suma M. Victor, et al. Multiple Giant Left Atrial Thrombi in Mitral Stenosis. (2017) J Heart Cardiol 3(2): 31- 32.
DOI: 10.15436/2378-6914.17.1226
Suma M. Victor, et al.
mailto:[email protected]://www.dx.doi.org/10.15436/2378-6914.17.1226
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Figure 2: Giant left atrial thrombus.
Discussion
Thrombi in LA occur nearly in 17% of patients with MS[1]. Frequent risk factors for thrombus formation are atrial arrhyth-mias, old age, and enlarged LA and low cardiac output state[2]. The common site for finding thrombi is in the left atrial appendage[3], based on the site of occurrence LA thrombi are classified into 7 types by Manjunath et al[4]. However, multiple thrombi are rarely seen in the present era even in developing countries. Although having multiple thrombi in LA increases the risk of stroke by mani-fold, our patient did not have any history of stroke even without any anticoagulation. Medical therapy in these patients include heart rate or rhythm control, anticoagulation to prevent thromboembolism, diuretics, prophylaxis against recurrent rheumatic carditis and infective endocarditis[5]. Definitive treatment includes mitral valve replacement with removal of thrombi and left atrial appendage exclusion to prevent further occurrence of thrombus formation. Prosthetic valve choice depends upon patient age, the risk of antico-agulation, and patient preference[6].
Supplementary: movie clips
Supplementary: movie clip 1
Atrial Thrombi in Mitral Stenosis
J Heart Cardiol | Volume 3 : Issue 2www.ommegaonline.org 32
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J Heart Cardiol | Volume 3 : Issue 2www.ommegaonline.org
Atrial Thrombi in Mitral Stenosis
Ommega Online PublishersJournal Title: Journal of Heart and CardiologyShort title : J Heart Cardiol
Journal ISSN: 2378-6914 (online)Journal E-mail: [email protected]: www.ommegaonline.org
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Supplementary: movie clip 2 “Back to Top”
References
1. Shrestha, N.K., Moreno, F.L., Narciso, F.V., et al. Two-dimensional echocardiographic diagnosis of left-atrial thrombus in rheumatic heart disease. A clinicopathologic study. (1983) Circulation 67(2): 341-347.Pubmed | Crossref | Others2. Fazlinezhad, A., Golmohammadzadeh, H., Azari, A., et al. Echocar-diographic Predictors of Left Atrial Thrombus in Patients With Severe Rheumatismal Mitral Stenosis. (2014) Razavi International Journal of Medicine 2(1): e15602.Crossref | Others3. Ali, S.N., Akram, M., Zareef, A. Comparison of Frequencies of Left Atrial Thrombus in Patients of Severe Mitral Stenosis with and Without Atrial Fibrillation Undergoing Transesophageal Echocardiography for Percutaneous Transv-septal Mitral Commissurotomy. (2015) P J M H S 9(4): 1166-1169.Others4. Manjunath, C.N., Srinivasa, K.H., Panneerselvam, A., et al. Inci-dence and predictors of left atrial thrombus in patients with rheumatic mitral stenosis and sinus rhythm: a transesophageal echocardiographic study. (2011) Echocardiography 28(4): 457-460.Pubmed | Crossref | Others5. Nishimura, R.A., Otto, C.M., Benow, R.O., et al. 2014 AHA/ACC guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Asso-ciation Task Force on Practice Guidelines. (2014) J Thorac Cardiovasc Surg 148(1): e1-e132.Pubmed | Crossref | Others6. Blase A. Carabello. Modern Management of Mitral Stenosis. (2005) Circulation 112(3): 432-437.Pubmed | Crossref | Others
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