Abstract
BackgroundLeft atrial thrombi are mostly related to mitral valve disease. The differential diagnosis of clots and myxomas in the left atrium is mostly based on echocardiography. Infection of intracardiac thrombi is extremely rare and mostly reported in ventricular clots or aneurysms following myocardial infarction.Case presentationWe present the case of a 65 year old female with a history of mitral valve disease and chronic atrial fibrillation who suffered repeated embolic strokes and a giant infected clot in the left atrium. Although the patient underwent prompt surgery with removal of the clot and valve replacement the complication of septic emboli to the CNS led her to death. To the best of our knowledge this is the second report of an infected left atrial thrombus.ConclusionThe case is a representative example of a neglected and undertreated patient with catastrophic consequences. Anticoagulant therapy in patients with mitral valve disease and atrial fibrillation should be applied according the currently available guidelines and standards in order to avoid analogous paradigms in the future. Mitral valve substitution should be considered in patients with mitral valve disease presenting thromboembolic complications. Surgery should be considered as the treatment of choice in cases of organized left atrial thrombus and suspected tumor or infected mass.
Highlights
Left atrial thrombi are mostly related to mitral valve disease
This report describes the case of a patient with a history of mitral valve disease and atrial fibrillation with repeated embolic strokes in the past presenting a giant infected clot in the left atrium
She had been suffering from mitral stenosis for 15 years and was under medical supervision, receiving digoxin, furosemide and warfarin
Summary
The case report presented is a representative example of a neglected and undertreated patient in refers to both surgical and medical aspects of her disease with extreme complications. In order to avoid such references in the future anticoagulant therapy must be used according to the currently recommended guidelines and standards and surgery must be considered in the setting of mitral valve disease complicated by systemic thromboemolism. In the presence of left atrial thrombus surgery should be offered in all patients with organized thrombus or suspicion of a tumor or an infected mass. 1. Inflammatory material from left atrium ventricle (H-E ×40), 2. Absence of microorganisms (Histochemical Grocott-Gomori stain) (×40), 6. Absence of microorganisms (Histochemical Giemsa stain) (×40). MFiigtruarleva6lve histology specimen Mitral valve histology specimen. Mitral valve with degenerative alterations (H-E ×40)
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