J 2020

Reccurent thrombus in the gigantic left atrium during effective anticoagulant therapy: case report

MASÁROVÁ, Lucia, Jan NOVÁK, Martin PEŠL, Jiří ONDRÁŠEK, Jiří SEMÉNKA et. al.

Basic information

Original name

Reccurent thrombus in the gigantic left atrium during effective anticoagulant therapy: case report

Authors

MASÁROVÁ, Lucia (703 Slovakia, guarantor, belonging to the institution), Jan NOVÁK (203 Czech Republic, belonging to the institution), Martin PEŠL (203 Czech Republic, belonging to the institution), Jiří ONDRÁŠEK (203 Czech Republic), Jiří SEMÉNKA (203 Czech Republic, belonging to the institution), Eva ŠIMAROVÁ and Roman PANOVSKÝ (203 Czech Republic, belonging to the institution)

Edition

BMC Cardiovascular Disorders, London, Biomed Central Ltd, 2020, 1471-2261

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

United Kingdom of Great Britain and Northern Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

Impact factor

Impact factor: 2.298

RIV identification code

RIV/00216224:14110/20:00115362

Organization unit

Faculty of Medicine

DOI

UT WoS

000517566900001

Keywords in English

Cardiac magnetic resonance; Echocardiography; Atrial fibrillation; Recurrent thrombus; Gigantic left atrium; Anticoagulant therapy

Tags

Tags

International impact, Reviewed
Změněno: 20/3/2020 11:40, Mgr. Tereza Miškechová

Abstract

V originále

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.