Floating left atrial thrombus and dysfunction of mitral prosthetic. A case report

Echocardiographic evidence of parietal atrial thrombus is frequently and easily diagnosed in mitral valve diseases. In the opposite, mobile left atrial thrombus is rare; its diagnosis require special attention. Our case report is about a 52 years old lady, with prothetic mitral valve and atrial fibrillation who presented with ischemic cerebral stroke. Oral anticoagulation was inappropriately observed. Transthoracic and transesophageal echocardiography showed an organised intra left atrial appendage thrombus with two floating thrombus into the left atrial cavity. In spite of adequate intravenous anticoagulation, the patient died within 48 hours after a massive second ischemic cerebral stroke. This case report shows the therapeutic challenge of left atrial thrombus management in the acute phase of ischemic cerebral stroke

[Women's left main coronary artery stenosis, about three cases]

Coronary insufficiency represents the first mortality cause for men over 45 years old and women over 65 years old. In the left main coronary artery stenosis the prognosis is more reserved especially in the case of unstable angina. We report 3 cases of left main coronary artery stenosis. It concerns three women of 49, 55 and 69 years old. They were menopaused, having hyperlipaemia and hypertension. The 69 years old woman has also type II diabetes mellitus. They were admitted for an unstable angina with a normal cardiovascular exam and a normal percritic electrocardiogram. A coronarography was carried out on all three patients highlighting in the 69 years old woman's case an isolated left main coronary artery stenosis; in 49 years old woman's case a distal tight left main coronary artery stenosis with two tight stenosis of left descending artery; and in 55 years old woman's case two tight stenosis of distal left main coronary artery and medial left descending artery. All three patients had a successful bypass graft surgery. In conclusion women's left main coronary artery stenosis with unstable angina can evolve well if it is well taken care of and at an early stage