Giant Left Atrial Thrombus Research Articles

Giant mobile thrombus in left atrium

Giant mobile left atrial thrombus has a rare occurrence. Rheumatic mitral valve stenosis (RMVS), which is frequently seen in developing countries, atrial fibrillation, and left atrial dilatation contribute to faster and higher volume thrombus formation. A 46-year-old female suffering from dyspnea was admitted to the cardiology outpatient. Transthoracic and transesophagial echocardiography confirmed rheumatic mitral stenosis with 3.5x 2.5 cm mobile circulating thrombus in left atrium. The patient underwent successful surgical thrombus removal, prostetic mitral valve replacement, and surgical ligation of the left appendage.

Catastrophic Cardiac Arrest Caused by Acute Pulmonary Hypertension After Removal of Giant Left Atrial Thrombus

<i>Background</i>: Pulmonary hypertension (PH) is defined as a resting mean pulmonary arterial pressure (mPAP) >20 mmHg on right heart catheterization, as described in the proceedings of the 6<sup>th</sup> World Symposium on Pulmonary Hypertension. Left-sided heart failure (left heart disease) is the most common cause of pulmonary hypertension (PH). Transesophageal echocardiography (TEE) plays an important role in the monitoring of PH. But the disadvantage of TEE is the lack of continuity of monitoring. For patients with severe mitral stenosis and severe PH, should the Swan-Ganz catheter be placed routinely? The monitoring of pulmonary artery pressure and pulmonary venous pressure by Swan-Ganz catheter can guide the management of perioperative circulation and respiration, especially for early detection of PH. <i>Case presentation</i>: This case report introduce a severe mitral valve stenosis with giant left atrium thrombosis performing cardiac surgery. After the removal of giant left atrial mass and mitral valve replacement under cardiopulmonary bypass (CPB), the patient gradually experienced difficulty in ventilation and persistent refractory hypotension, followed by ventricular fibrillation during the process of chest closure. <i>Conclusions</i>: TEE helps diagnose acute pulmonary hypertension. Although TEE plays an important role in the diagnosis and the decision to use mechanical devices, a Swan-Ganz catheter would be an effective hemodynamic monitoring device and can be used in conjunction with TEE in cardiac surgery.

Giant Left Atrial Thrombus in a Heart Transplant Recipient - Risk Factors and Diagnostic Approach

<h3>Introduction</h3> The left atrium (LA) in heart transplant (HT) recipients is a surgically created chamber from different portions of donor and recipient atria and is thus frequently enlarged. It was hypothesized that remaining sutures and LA enlargement may precipitate LA thrombus (LAT) formation, but LAT following bi-caval anastomosis has seldom been described. We report a case of a giant LAT diagnosed upon routine transthoracic echocardiography in an asymptomatic HT recipient. <h3>Case Report</h3> A 58 y/o man with non-ischemic cardiomyopathy underwent orthotopic HT (bi-caval technique) from a 30 y/o donor with head trauma. Perioperative course and long-term follow up were uneventful, except for an early single self-resolving episode of atrial fibrillation (AF). Chronic aspirin therapy was administered per institutional protocol. The immunosuppression protocol included tacrolimus, mTORi and prednisone. Five years after HT, routine follow up TTE revealed, within a known enlarged LA (AP diameter 56mm, area 30mm²), a new large fixed mass (29*39mm) that had not been evident on previous TTEs done every 3 months. Blood count, electrolytes, and CRP were unremarkable; no arrhythmia was documented. Transesophageal echocardiography revealed a large immobile echogenic mass attached to the interatrial septum (Fig. 1A), and ECG-gated CT revealed a non-contrast enhancing filling defect (36*31*39mm) adjacent to the interatrial septum (Fig. 1B). Cardiac MRI showed a homogenous non-gadolinium enhancing mass adherent to the interatrial septum at the upper pole of the LA. Collectively, these findings were consistent with a diagnosis of LAT. Anticoagulation therapy was initiated, and mTORi was withdrawn; no further embolic events were recorded. <h3>Summary</h3> Remaining sutures, enlarged LA, history of AF and immunosuppressive therapies may play a role in thrombus formation. Systematic echocardiographic surveillance post-HT should be considered for early diagnosis and treatment of this potentially devastating complication.

A Case of Giant Mobile Left Atrial Thrombus during Dabigatran Therapy

A Case of Giant Mobile Left Atrial Thrombus during Dabigatran Therapy

Extraction through Minimal Invasive Partially Video-Assisted Anterolateral Right Thoracotomy of a Voluminous Left Atrial Thrombus Due to Unregulated Warfarin Treatment

A 62-year-old female patient with history of atrial fibrillation and protein C and S deficiency was admitted for acute dyspnea. Laboratory control demonstrated an unregulated warfarin treatment. Transthoracic echocardiography and computed tomography revealed a giant left atrial thrombus and a severe mitral stenosis. The day after admission a full body tomography revealed spleen emboli and non-violation of hematoencephalic barrier. Surgical thrombus extraction and mitral valve replacement were successfully performed by minimal invasive, partially video-assisted, right anterolateral thoracotomy. Echocardiographic control after two months showed no evidence of residual thrombus. Massive left atrial thrombosis must be operated urgently because of the imminent risk of embolization. The described technique represents a good compromise between full video-assisted port-access surgery and traditional midline sternotomy.

'What you see is what you'll get': giant extra-appendage left atrial thrombus after left atrial appendage occlusion for persisting left atrial appendage thrombus.

'What you see is what you'll get': giant extra-appendage left atrial thrombus after left atrial appendage occlusion for persisting left atrial appendage thrombus.

Almost disappearance of giant left atrial thrombus in mitral stenosis with systemic embolization under intravenous heparin administration

Almost disappearance of giant left atrial thrombus in mitral stenosis with systemic embolization under intravenous heparin administration

A Giant Left Atrial Thrombus After Radiofrequency Catheter Ablation

A Giant Left Atrial Thrombus After Radiofrequency Catheter Ablation

Left atrial thrombus in a patient without mitral valve disease or atrial fibrillation

A 54-year-old man presented with back pain. His medical history included hypertension and gout. There was no history of heart disease or arrhythmia. The electrocardiogram showed normal sinus rhythm. Chest computed tomography demonstrated a large calcified tumor (65mm) in the left atrium (LA). The echocardiogram showed a round hyperechoic mass in the enlarged LA (56mm) attached to the atrial septum without mitral valve disease. Urgent surgery for excision of the LA mass with the atrial septum and reconstruction by autologous pericardial patch was performed. There was no pathological change in the mitral valve. Due to surgical injury to the conduction system, implantation of a permanent pacemaker was required postoperatively. Histopathological examination revealed calcification, fibrosis, and thrombus formation. LA thrombus without any history of mitral valve disease or atrial fibrillation is rare. Although the mechanism of the present case was unclear, extensive calcified LA myxoma or undiagnosed patent foramen ovale might have been associated with the disease.<Learning objective: A smooth surface, floating left atrial “ball thrombus” occurs rarely in patients with mitral valve disease or atrial fibrillation. We present a rare case of a giant round left atrial thrombus in a patient without any history of mitral valve disease or atrial fibrillation. Transesophageal echocardiogram showed that the thrombus was round, fixed to the septum, and not floating, and that its surface was calcified. This disease in this patient might have been associated with extensive calcified left atrial myxoma, paroxysmal atrial fibrillation, or undiagnosed patent foramen ovale.>

Stereotactic radiotherapy for the treatment of lung cancer with a giant left atrial tumor thrombus: A case report and literature review.

Lung cancer presenting with a giant atrial tumor thrombus is particularly rare. Surgical resection, aided by a cardiopulmonary bypass, is the standard treatment of choice if there is no distant metastasis. However, this form of surgery carries a high risk, with the subsequent patient prognosis being extremely poor. The current study describes the case of a 52-year-old man presenting with left lung squamous cell carcinoma that had extended into the left atrium. The patient was treated with stereotactic radiotherapy, and regarding the atrial disease, a complete response was achieved within 12 months. The present case demonstrates that stereotactic radiotherapy may be a beneficial palliative treatment for patients with stage IV lung cancer invading the left atrium.

A fortunate outcome after electrical cardioversion with a giant persistent left atrial thrombus. Is TOE-guided strategy more preferable in high risk patients?

A fortunate outcome after electrical cardioversion with a giant persistent left atrial thrombus. Is TOE-guided strategy more preferable in high risk patients?

Resolution of giant left atrial appendage thrombus with rivaroxaban

doi:10.1160/TH12-11-0821 Thromb Haemost 2013; 109: 583–584 A 64-year-old man was transferred to our hospital for external cardioversion (ECV) of symptomatic persistent atrial fibrillation (AF). At the time of hospital admission the patient presented with functional NYHA class III; he had a clinical history of symptomatic coronary artery disease, ischaemic cardiomyopathy with severely impaired left ventricular function, and chronic kidney disease stage 3B to 4 (creatinine clearance [CrCL] 29 ml/minute). Pretreatment with the vitamin-K antagonist (VKA) phenprocoumon was instituted in 2006 due to a high AF related thromboembolic risk with an actual CHA2DS2VASc score of 6. Since the international normalised ratio (INR) was not well controlled before elective ECV we performed a transesophageal echocardiography (TEE), which revealed a small thrombus formation (11 x 12 mm) in the apex of the left atrial appendage (LAA) (▶ Figure 1 A). Therefore, ECV was deferred for six weeks under closely controlled VKA therapy with levels of INR ranging between 2.5 – 3.5 (mean 3.2 ± 0.7, range 2.4 to 4.2). Interestingly, repeated TEE (▶ Figure 1 B) showed a markedly increased giant thrombus mass (12 x 45mm) now protruding into the left atrium. In general VKAs have a slow onset of action and their indirect anticoagulant activity depends on clearance of the vitamin K–dependent clotting proteins and replacement with functionally impaired factors (1). In contrast to current guidelines, there is increasing evidence that VKAs have a poor capability to resolve large intracardiac thrombi. Therefore, we decided to switch oral anticoagulation (OAC) to the direct factor Xa (FXa) inhibitor rivaroxaban dosed with 15 mg once daily. After four weeks of rivaroxaban treatment TEE showed a relevantly decreased thrombus size (▶ Figure 1 C) and a complete thrombus resolution was achieved after six weeks of anticoagulant therapy with the FXa inhibitor (▶ Figure 1 D). Finally, ECV was performed successfully without clinical signs of cardiac embolism and the patient was discharged in good medical conditions under continued anticoagulant treatment with rivaroxaban. To the best of our knowledge this is the first documented case of LAA thrombus resolution under rivaroxaban therapy and illustrates some clinically important characteristics of the new direct acting FXa inhibitor. First, in contrast to indirect acting VKAs, FXa inhibitors have the potential to (a) prevent de novo thrombus formation and more importantly (b) to resolve established thrombi by direct inhibition of free and thrombusassociated FXa. Thereby they reduce clot-induced fibrinopeptide A generation to a similar extent as hirudin, a potent inhibitor of thrombin (2).

Giant left atrial thrombus caused by direct invasion of lung cancer.

A 60-year-old man came to our hospital with dyspnea and was found at the front of our hospital due to syncope. He had cystic lung disease and a 2-month history of progressively worsening dyspnea. He regained consciousness in the emergency room; however, his lips were cyanotic and oxygen saturation was 70 %. He was afebrile, with a blood pressure of 116/79 mmHg and a heart rate of 70 bpm. There was no heart murmur, moist rale, or peripheral edema. Chest radiography showed pulmonary edema with bilateral pleural effusion. Electrocardiogram showed biphasic pulmonary P waves with regular sinus rhythm. Echocardiography demonstrated that the left atrium (LA) was occupied by a giant mass (7.6 9 4.8 cm, Fig. 1a, b). The mass was of low density and homogenous, and the mobility was poor. It was unclear whether the mass had a stalk or was attached on the LA wall. Color Doppler method revealed that the mass disturbed the left ventricular inflow (Fig. 1c, d). The mass was presumed to be a myxoma because he had been asymptomatic with sinus rhythm for a long time. He was referred to another hospital for emergency surgery. Just after the transfer, he was examined by chest enhanced computed tomography (CT) in the emergency room. The findings indicated a right lung cancer (Fig. 2, yellow arrow). The tumor directly infiltrated the wall of the LA. In addition, the mass in the LA, which was of homogenous low density without enhancement, was suspected to be thrombus (Fig. 2, white arrow). By the findings of a blood sampling examination (FDP 6.4 lg/ml, D-dimer 4.0 lg/ml), it was suspected that there was intracardiac thrombus, chronic DIC state, and/or deep vein thrombosis. He was diagnosed as having primary lung cancer with direct invasion into the LA and thrombus of the LA. Emergency surgery was considered; however, he was treated conservatively because the lung cancer was of stage IV. He was kept under sedation due to worsening dyspnea and eventually died of respiratory and circulatory disturbance on the 6th day of hospitalization. The pathological findings were: (1) primary lung adenocarcinoma in the right hilum pulmonis and the lower lobe with direct invasion to the LA and (2) stratified thrombus in the LA (the core of thrombus was the carcinoma cells in the LA). This is a rare case of a giant LA thrombus with direct invasion of lung cancer into the left atrium. The thrombus was first suspected as myxoma because of the patient’s history of illness and the echocardiographic findings (low density, homogenous) without atrial fibrillation. It seems that projecting carcinoma cells to the LA became the core and the LA thrombus stratified as it grows into a chronic DIC state based on malignancy. Few cases of intracardiac extension of lung cancer [1] and LA thrombus caused by direct invasion [2] have been reported. In urgent patients with circulatory disturbance, we have to make a decision M. Iwai-Takano (&) Intensive Care Unit, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima 960-1295, Japan e-mail: masumi@fmu.ac.jp

Free-floating giant left atrial ball thrombus with aortic valve disease--a rare entity and a near miss

Large left atrial mural thrombi in the absence of mitral valve stenosis have been reported rarely in the literature. It is even rarer without history of atrial fibrillation (AF). These masses can cause systemic embolization and sudden circulatory collapse when they obstruct the mitral valve. We are presenting a case of giant, free floating ball thrombus, detected after aortic valve replacement for mixed aortic valve disease. It was found immediately before separation from cardiopulmonary bypass by transoesophageal echocardiography and was successfully removed. A ball thrombus without mitral valve disease and AF with aortic valve disease is not yet reported in the literature.

Giant Left Atrial Thrombus in the Patient of Hypertrophic Cardiomyopathy A: Case Report

Giant Left Atrial Thrombus in the Patient of Hypertrophic Cardiomyopathy A: Case Report

Uneventful Disappearance of a Large Left Atrial Ball Thrombus with Enoxaparin in a Patient with Mitral Stenosis Associated with Pregnancy

An atrial thrombus is a relatively common echocardiographic finding in patients with mitral valve stenosis (MVS) and atrial fibrillation (AF). However, a “ball thrombus” or floating thrombus in the left atrium is a rare and specific entity associated with MVS. A 24-year-old woman with rheumatic MVS presented with complaints of progressive dyspnea and inferior limbs edema that began 23 days earlier after a caesarean operation for stillbirth carried out at 8 months of pregnancy. At the time of hospitalization, she was in New York Heart Association functional class III and the ECG showed sinus rhythm. Transthoracic color-flow Doppler echocardiography revealed a thick, stenotic mitral valve with a valvular area of 0.9 cm2, and an echogenic large left-atrial mass diagnosed as a free-floating left-atrial thrombus that was corroborated by transesophageal echocardiography. She refused surgery and was treated medically, and low molecular weight heparin (LMWH) (enoxaparin 80 mg/12 h) was given for 14 days and was discharged uneventfully on coumarin. Two days before discharge, a transthoracic and transesophageal ecocardiography showed disappearance of the ball thrombus uneventfully leaving spontaneous echo contrast inside the left atrium. To the best of our knowledge, this is the first case showing disappearance of a giant left atrial ball thrombus with LMWH treatment in a patient with severe MVS during sinus rhythm associated with pregnancy.

“A case of mobile giant left atrial thrombus which vascularized with coronary arteries in severe mitral valve stenosis,” published in Cardiovascular Revascularization Medicine 2010;11(2):71–138

We have read with interest the article of Acet et al. [1] published in this journal. We recently had a similar case of a 61-year-oldmale patient with severe rheumatic mitral stenosis and atrial fibrillation. The patient was admitted in our clinic for minimal exertional dyspnea (NYHAClass 3). Clinically, we noted the augmentation of the intensity of the first cardiac sound, complete arrhythmia corresponding with atrial fibrillation on the EKG, and hepatomegaly. The transthoracic echocardiogram revealed a severe rheumatic mitral stenosis with a planimetric area of the mitral orifice of 0.8 cm and the presence of an echogenic pediculated mass of large dimensions (Fig. 1) inside the left atrium. The mass seemed to be attached to the atrial dome and was partially mobile. The left atrium was also dilated. The very severe pulmonary hypertension (140 mmHg) in the presence of the 0.8-cm mitral valve area raises the question about the etiology of pulmonary hypertension: Was it secondary to mitral valve disease? Does it have an essential component or was it caused by an obstructive mechanism created by the atrial mass?

Successful anticoagulation for treatment of a giant left atrial thrombus

We report the discovery at transthoracic echocardiography of a very large, sessile formation in the left atrium in a 77-year-old woman with permanent non-valvular atrial fibrillation who did not receive anticoagulant therapy. After six weeks of anticoagulation by subcutaneous low-molecular-weight heparin, a control echocardiogram demonstrated an almost complete resolution of the mass without systemic embolisation. This case highlights the success, without complications, of a medical anticoagulant therapy for giant left atrial thrombus.

A case of mobile giant left atrial thrombus which vascularized with coronary arteries in severe mitral valve stenosis

A case of mobile giant left atrial thrombus which vascularized with coronary arteries in severe mitral valve stenosis

Giant Left Atrial Thrombus Associated with Ablation for Atrial Tachycardia

We report a very rare case of giant left atrial thrombus (size: 7.2 x 4.5 mm(2)) associated with radiofrequency catheter ablation for atrial tachycardia in a 72-year-old man. After 4 weeks of anticoagulation with warfarin, a repeat echocardiogram demonstrated partial resolution of the thrombus (size: 4.5 x 2.6 mm(2)) without systemic embolization.