Reccurent thrombus in the gigantic left atrium during effective anticoagulant therapy: case report
Abstract Background Gigantic left atrium is defined in the current literature as an excessive dilatation of the left atrium above 65mm. Chronic mitral valve disease is associated with the development of thrombus in the left atrium in up to 19% of all cases of mitral insufficiency and appropriate tre...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-02-01
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| Series: | BMC Cardiovascular Disorders |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12872-019-01279-1 |
| _version_ | 1819015849024946176 |
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| author | Lucia Masarova Jan Novak Martin Pesl Jiri Ondrasek Jiri Semenka Eva Simarova Roman Panovsky |
| author_facet | Lucia Masarova Jan Novak Martin Pesl Jiri Ondrasek Jiri Semenka Eva Simarova Roman Panovsky |
| author_sort | Lucia Masarova |
| collection | DOAJ |
| description | Abstract Background Gigantic left atrium is defined in the current literature as an excessive dilatation of the left atrium above 65mm. Chronic mitral valve disease is associated with the development of thrombus in the left atrium in up to 19% of all cases of mitral insufficiency and appropriate treatment must be initiated to prevent thromboembolic events. In order to diagnose thrombi in the left atrium or left atrial appendage, various imaging methods may be used, including cardiac magnetic resonance. Case presentation The case report describes a 73-year-old male who developed recurrent sessile thrombus on the posterior wall of the gigantic left atrium. A large thrombus was first detected following mitral valve surgery despite effective vitamin K antagonist anticoagulation therapy. Echocardiography and cardiac magnetic resonance were used within the diagnostic procedure and to monitor the treatment outcomes. Cardiac magnetic resonance was shown to be beneficial as it provided a more precise description of the intra-atrial masses located on the posterior left atrial wall, and in such situations, is of greater benefit than standard echocardiography. This led to the surgical removal of the intra-atrial mass; nevertheless, it was quickly followed by the recurrence of the thrombus. The anticoagulant therapy was adjusted and fortified by the introduction of acetylsalicylic acid and sequentially clopidogrel, but this also did not resolve the thrombus formation. Finally, employing a combination of rivaroxaban and clopidogrel resulted in partial thrombus regression. Therefore, various pathophysiological aspects of thrombus formation and used anticoagulation strategies are discussed. Conclusions We describe a unique case of a recurrent thrombus located on the posterior wall of the gigantic left atrium. Cardiac magnetic resonance was shown to be beneficial in providing a more precise description of the intra-atrial masses located on the posterior left atrial wall as compared to standard echocardiographic examination. Development of a thrombus after mitral valve surgery despite effective anticoagulant therapy and its final resolution by introducing a combination of rivaroxaban and clopidogrel highlights the complex etiopathogenesis of thrombus formation. This supports the potential use of this combination in tailoring an individual personalized therapy for patients with recurrent atrial thrombi. |
| first_indexed | 2024-12-21T02:38:16Z |
| format | Article |
| id | doaj.art-51f2075ca9cd4c45b268b92ea9fd968f |
| institution | Directory Open Access Journal |
| issn | 1471-2261 |
| language | English |
| last_indexed | 2024-12-21T02:38:16Z |
| publishDate | 2020-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cardiovascular Disorders |
| spelling | doaj.art-51f2075ca9cd4c45b268b92ea9fd968f2022-12-21T19:18:45ZengBMCBMC Cardiovascular Disorders1471-22612020-02-012011710.1186/s12872-019-01279-1Reccurent thrombus in the gigantic left atrium during effective anticoagulant therapy: case reportLucia Masarova0Jan Novak1Martin Pesl2Jiri Ondrasek3Jiri Semenka4Eva Simarova5Roman Panovsky6First Department of Cardioangiology, St. Anne’s University Hospital and Faculty of Medicine, Masaryk UniversitySecond Department of Internal Medicine, St. Anne’s University Hospital and Faculty of Medicine, Masaryk UniversityFirst Department of Cardioangiology, St. Anne’s University Hospital and Faculty of Medicine, Masaryk UniversityCenter for Cardiovascular Surgery and Organ TransplantationFirst Department of Cardioangiology, St. Anne’s University Hospital and Faculty of Medicine, Masaryk UniversityDepartment of Radiology, St. Anne’s University Hospital and Masaryk UniversityFirst Department of Cardioangiology, St. Anne’s University Hospital and Faculty of Medicine, Masaryk UniversityAbstract Background Gigantic left atrium is defined in the current literature as an excessive dilatation of the left atrium above 65mm. Chronic mitral valve disease is associated with the development of thrombus in the left atrium in up to 19% of all cases of mitral insufficiency and appropriate treatment must be initiated to prevent thromboembolic events. In order to diagnose thrombi in the left atrium or left atrial appendage, various imaging methods may be used, including cardiac magnetic resonance. Case presentation The case report describes a 73-year-old male who developed recurrent sessile thrombus on the posterior wall of the gigantic left atrium. A large thrombus was first detected following mitral valve surgery despite effective vitamin K antagonist anticoagulation therapy. Echocardiography and cardiac magnetic resonance were used within the diagnostic procedure and to monitor the treatment outcomes. Cardiac magnetic resonance was shown to be beneficial as it provided a more precise description of the intra-atrial masses located on the posterior left atrial wall, and in such situations, is of greater benefit than standard echocardiography. This led to the surgical removal of the intra-atrial mass; nevertheless, it was quickly followed by the recurrence of the thrombus. The anticoagulant therapy was adjusted and fortified by the introduction of acetylsalicylic acid and sequentially clopidogrel, but this also did not resolve the thrombus formation. Finally, employing a combination of rivaroxaban and clopidogrel resulted in partial thrombus regression. Therefore, various pathophysiological aspects of thrombus formation and used anticoagulation strategies are discussed. Conclusions We describe a unique case of a recurrent thrombus located on the posterior wall of the gigantic left atrium. Cardiac magnetic resonance was shown to be beneficial in providing a more precise description of the intra-atrial masses located on the posterior left atrial wall as compared to standard echocardiographic examination. Development of a thrombus after mitral valve surgery despite effective anticoagulant therapy and its final resolution by introducing a combination of rivaroxaban and clopidogrel highlights the complex etiopathogenesis of thrombus formation. This supports the potential use of this combination in tailoring an individual personalized therapy for patients with recurrent atrial thrombi.http://link.springer.com/article/10.1186/s12872-019-01279-1Cardiac magnetic resonanceEchocardiographyAtrial fibrillationRecurrent thrombusGigantic left atriumAnticoagulant therapy |
| spellingShingle | Lucia Masarova Jan Novak Martin Pesl Jiri Ondrasek Jiri Semenka Eva Simarova Roman Panovsky Reccurent thrombus in the gigantic left atrium during effective anticoagulant therapy: case report BMC Cardiovascular Disorders Cardiac magnetic resonance Echocardiography Atrial fibrillation Recurrent thrombus Gigantic left atrium Anticoagulant therapy |
| title | Reccurent thrombus in the gigantic left atrium during effective anticoagulant therapy: case report |
| title_full | Reccurent thrombus in the gigantic left atrium during effective anticoagulant therapy: case report |
| title_fullStr | Reccurent thrombus in the gigantic left atrium during effective anticoagulant therapy: case report |
| title_full_unstemmed | Reccurent thrombus in the gigantic left atrium during effective anticoagulant therapy: case report |
| title_short | Reccurent thrombus in the gigantic left atrium during effective anticoagulant therapy: case report |
| title_sort | reccurent thrombus in the gigantic left atrium during effective anticoagulant therapy case report |
| topic | Cardiac magnetic resonance Echocardiography Atrial fibrillation Recurrent thrombus Gigantic left atrium Anticoagulant therapy |
| url | http://link.springer.com/article/10.1186/s12872-019-01279-1 |
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