A Case of Giant Mobile Left Atrial Thrombus during Dabigatran Therapy / 日本心臓血管外科学会雑誌

Dabigatran is a new/direct oral anticoagulant drug unlike warfarin. It is being increasingly used to prevent thromboembolism in patients with nonvalvular atrial fibrillation. We present the case of a 77-year-old woman with a giant left atrial thrombus in spite of anticoagulation therapy with dabigatran 300 mg/day. She had developed a cerebral infarction 18 months previously and was switched from warfarin to dabigatran. However, magnetic resonance imaging showed multiple new cerebral infarcts, and computed tomography scan and echocardiogram revealed a giant thrombus measuring 37×29 mm in the left atrium. Thrombectomy and left atrial appendage closure were urgently performed. Dabigatran was changed to warfarin again after the operation. She has had no recurrent thromboembolic event since then.

Blooming Flower in Misty Left Atrium

No abstract available.

Floating Bodies in the Left Atrium by 2D-echo: A Differential Diagnosis.

Two-dimensional echocardiography (2D-echo) is sensitive in detecting floating bodies in the left atrium. Identification of a freefloating left atrial thrombus, as a source of embolus, is a common indication for 2D-echo. Screening for other cardiac conditions such as valvular heart diseases often, if not common, reveal floating bodies in the left atrium. The differential diagnosis of a floating body in the left atrium will be discussed.

Multiple Papillary Fibroelastomas and Thrombus in the Left Heart

Cardiac papillary fibroelastomas (CPF) are benign cardiac tumors and usually discovered incidentally during echocardiography. This report describes the case of a 68-year-old man, referred to cardiology for multiple masses of the left ventricle and left atrium. The transthoracic echocardiography revealed multiple oscillating masses in the left ventricle and aortic valve, non-mobile mass in the left atrium with severe mitral stenosis and moderate aortic regurgitation. The patient underwent surgical resection of the masses with valve replacements. Histopathologic examination confirmed the diagnosis of CPF in the left ventricle and aortic valve, thrombus in the left atrium.

Values of three scoring systems in predicting left atrial thrombus in patients with non-valvular atrial fibrillation / 第二军医大学学报

Objective: To evaluate the values of CHADS2 score, CHA2DS2-VASc score, and sel--modified CHA2DS2-VASc-LA2 score in predicting left atrial thrombus (LAT) in patients with non-valvular atrial fibrillation (NVAF). Methods: A total of 203 NVAF patients who underwent transesophageal echocardiography (TEE) examination and cardiac multislice CT scans before AF radiofrequency ablation in our department from June 2007 to June 2012 were included in this study. LAT was detected by TEE in 39 patients (thrombosis group) and not detected in 164 patients (control group). The patients' general condition, medical history, admission examination, CHADS2 score and CHA2DS2-VASc score were subjected to univariate analysis and multivariate logistic regression analysis. Then a new CHA2DS2-VAS-LA2 scoring system was formed by combining le!t atrial volume index (LAVI), recording LAVI ≥32 mL/m2 as 2 points and CHA2DS2-VASc score, which was based on the results of logistic regression analysis. The receiver operating characteristic curve (ROC) was used to compare the values of CHADS2, CHA2DS2-VASc and CHA2DS2-VASc-LA2 scores for predicting LAT formation in NVAF patients. Results: ROC curve analysis showed that CHADS2 score had a low predictive value (AUC [area under the curve] = 0.661, P = 0.002); CHA2DS2-VASc score (AUC=0. 731, P<0. 001) and CHA2DS2-VASc-LA2 score (AUC= 0.771, P<0.001) had middle predictive values. The CHA2DS2-VASc-LA2 scores of the three patients with CHADS2 score being 0 in thrombosis group was increased, and there was no patient in the thrombosis group with CHA2DS2-VAS-LA2 score being 0. Conclusion: Compared with CHADS2 and CHA2DS2-VASc systems, CHA2DS2-VASc-LA2 score has a better performance in predicting LAT in low-risk patients with NVAF. It is also suggested that pre-ablation TEE may be unnecessary f the CHA2DS2-VASc-LA2 score is 0.

Black Defects in Severe Spontaneous Echo Contrast Teach Us the Protective Aspect of Mitral Regurgitation Visually

No abstract available.

Left Atrial Thrombus Diagnosed by Transesophageal Echocardiography Immediately after Induction in a Patient with Middle Cerebral Artery Infarction: A case report / 대한마취과학회지

Stroke is one of the most common causes of death; in particular, cardiac source of embolism may be responsible for 15-20% of ischemic strokes. Here we report a case of left atrial thrombus diagnosed by transesophageal echocardiography (TEE) immediately after induction of general anesthesia in a patient with infarction of the middle cerebral artery. In this case, an emergent craniectomy was cancelled and medical treatment was performed. This case report shows that TEE taken in the operating room may play an important role in the change of treatment plan in a patient displaying acute mental change.

Free-Floating Left Atrial Thrombus with Recurrent cerebral Embolic Event Associated Mitral Stenosis

In mitral valve disease, left atrial thrombus is a common finding, particularly in left atrial appendage in patients with atrial fibrillation. But free-floating thrombus is rare. Nevertheless, it is an important and potentially fatal complication because it can cause sudden arrest by obstucting the mitral orifice, or serious cerebral and peripheral embolic events. Therefore it is important to early detect such lesions. It usually occurs in the setting of a large, dilated left atrium with stagnant flow, commonly the result of severe rheumatic mitral stenosis and accompanying atrial fibrillation. We report the clinical and echocardiographic findings in a patient with left atrial free-floating thrombus who had two episodes of cerebral embolic event.

Left Atrial Thrombus and Spontaneous Echo Contrast in Mitral Valvular Heart Disease : Its Clinical Significance and the Role of Transesophageal Echocardiography

BACKGROUND: Left atrial thrombi(LAT) and spontaneous echo contrast(SEC) are known as major risk factors for thromboembolic complication in patients with mitral valvular heartdisease. Recent clinical introduction of transesophageal echocardiography(TEE) makes it possible to improve the diagnostic accuracy of these risk facors compared to conventional transthoracic echocardiography(TTE). The aims of the present study were to evaluate diagnostic accuracy of TEE for detection of LAT and to determine if clinical and echocardiographic variables can predict the presence of LAT and/or SEC at TEE. METHODS: From July 1991 to April 1993, both TTE and TEE were performed in 84 patients with mitral valvular heart disease before open heart surgery. The incidence and diagnostic accuracy of TTE and TEE for LAT detection were confirmed at surgery for mitral valve replacement in all cases. Biplane with 5.0 MHz transducer was used in TEE. The following clinical and transthoracic echocardiographic variables were analyzed:age, totoal or recent embolism, atrial fibrillation, left atrial dimension, ejection fraction, mitral valve area, and mitral regurgitation. RESULT: 1) THe sensitivity of TEE for detection of LAT was 100%, which was significantly higher than that of TTE(60.8%). There was no statistical difference in specificity of both techniques(98.3% vs 93.4%). In eleven patients (11/24,45.8%), LAT was confined to the left atrial appendage and TEE was far superior to TTE(sensitivity : 100% vs 27.2%) in detection of appendegeal thrombi. 2) SEC was found in 43 patients(51.2%). Patients with SEC had higher rates of LAT(p<0.001) and embolic episodes (p=0.001) than patients without SEC. There was no association between the severity of SEC and the embolic episodes. 3) Patients with SEC or LAT were characterized by more frequently associated with recent embolic episodes, smaller mitral valve orifice, abscence of mitral regurgitation than those without SEC and LAT. CONCLUSION: TEE is superior to TTE in detection of LAT and appendegeal thrombi. SEC is frequently noted in TEE and also strongly associated with left atrial blood stasis and left atrial thrombi in mitral valve disease.

Predictors of Left Atrial Thrombus in Mitral Stenosis A Transthoracic and Transesophageal Echocardiographic Study

BACKGROUND: Left atrial thrombus(LAT) has long been recognized as a complication of mitral stenosis(MS).The transesophageal echocardiographic approach readily visualize LAT. We evaluated the risk factors for left atrial thrombus in patients with MS using transthoracic(TTE) and transesophageal echocardiography(TEE). METHODS AND RESULTS: One hundred and forty-three(patients) who had moderate to severe MS were consecutively studied with TTE and TEE. They were 43 males(30%) and 100 females(70%).The mean age was 44+/-11 years(range 21-70). Twenty-five patients had at least one episode of embolic events. Ninety-six patients were in atrial fibrillation(AF). LAT was detected in 30 pts(21%) : 16 had thrombus confined to the LA appenge(LAA), 14 to true LA cavity and/or LAA. TTE variables were compared between LAT group and non-LAT group. Univariate predictors of LAT were mitral valve area(MVA)(0.78+/-0.22cm2 vs 1.05+/-0.32cm2, p=0.001), pressure half time(353+/-88ms vs 258+/-118ms, p=0.002). LV ejection fraction(EF)(55+/-11% vs 62+/-8%,p=0.008), LA size (58+/-11mm vs 52+/-7mm, p=0.033) and AF(p=0.001). Stepwise logistic regression analysis revealed significant independent predictors of LAT to be AF(p=0.02), MVA(p=0.02) and EF(p=0.03). CONCLUSION: Left atrial thrombus was not uncommon in patients with rheumatic mitral stenosis. Small mitral valve area and reduced ejection fraction of left ventricle appear to be significant predictors of LAT in mitral stenosis with atrial fibrillation.

Coronary Neovascularity and Fistula Formation in Left Atrial Thrombosis

In mitral valve disease, mural thrombus in the left atrium is common, particulary in the atrial appendage in patients with atrial fibrillation. Occasionally, the angiographic sign of "neovascularity" and "fistula" in the region of the left atrial appendage during coronary arteriography has been reported to indicate the presence of thrombus in the left atrium, which might not even be revealed by transthoracic two-dimensional echocardiography. We observed coronary neovascularity and fistula formation in two pateints with mitral stenosis and these findings were due to organized mural thrombus that was adherent to the wall of the left atrial appendage. So we report 2 cases with brief review of literature.