Inhibition of SA Node at Supine Position in Right Atrial Thrombus Complicating Behçet’s Disease – From Cardiac Surgical Point of View

Abstract

Patient: Female, 27Final Diagnosis: Right atrial thrombus compressing the sinoatrial nodeSymptoms: Dyspnea • cough and hemoptysis with supine bradycardia reaching 36/min and dizzinessMedication: —Clinical Procedure: Cardiac surgical intervention removing the mechanical cause if conservative management failed can be done safelySpecialty: SurgeryObjective:Rare diseaseBackground:Behçet’s disease (BD) is a chronic multi-systemic disease of unknown cause. Intra-cardiac thrombus (ICT) complicating BD is extremely rare. In general, cardiac manifestations in BD are associated with poor prognosis. Chest computed tomography (CT) scan and echocardiogram are excellent modalities for diagnosis and patient assessment. Cardiac surgical intervention can be done safely using an on-pump technique when medical management has failed.Case Report:We report on a case of a 27-year-old Jordanian woman diagnosed with BD who presented with dyspnea, cough, and hemoptysis, with supine bradycardia reaching 36 beats/minute and dizziness which disappear on sitting or standing position, and with heart rate reaching 76 beats/minute. Right atrial thrombus was identified using transthoracic echocardiogram and chest CT scan. After medical management failed, cardiac surgical intervention became an option and targeted extraction of the right atrial thrombus compressing the sinoatrial node (SA node).Conclusions:In BD, right atrial thrombus compressing the SA node is rare. If conservative management has failed, cardiac surgical intervention removing the mechanical cause can be done safely, either using on-pump with cross clamp or on-pump with beating heart technique.