Management of emergency care, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)
Takayuki Yoshioka, Takeshige Mori, Yayoi Taniguchi, Sonoko Hirayama, Toru Ozawa, Sachiyo Iwata, Asumi Takei, Nobutaka Inoue
Department of Cardiovascular Medicine, Kobe Rosai Hospital, Kobe, Hyogo, Japan
Am J Case Rep 2017; 18:324-328
A free-floating ball thrombus in the left atrium is a rare clinical condition. However, the diagnosis of this condition has been facilitated by the advent and development of echocardiography and multi-detector row computed tomography (MDCT) and several cases have been reported.
CASE REPORT: We report a case of a 75-year-old woman who had recurrent giant spherical thrombi in the left atrium. She was diagnosed with chronic atrial fibrillation at 52 years of age. A pacemaker implantation was performed at 54 years of age because of a complete atrioventricular block; and mitral valve replacement was performed for severe mitral regurgitation at 62 years of age. She had a history of cerebral infarction and she was under treatment for chronic heart failure.
Despite intensive anticoagulant therapy, she developed ball thrombi in the left atrium three times in six months. During hospitalization for acute myocardial infarction treated with percutaneous catheter intervention, transthoracic echocardiography and computed tomography (CT) revealed a free-floating giant spherical thrombus in the left atrium. She was treated with intensive anticoagulation therapy and the left atrial ball thrombus disappeared; however, two ball thrombi in the left atrium and left atrial appendage recurred after three months. Surgical removal of the thrombi and closure of the left atrial appendage were performed. Unfortunately, a ball thrombus in the left atrium recurred again after a further three months.
CONCLUSIONS: The present case highlights the difficulty of treating refractory thrombi in the left atrium.
Keywords: Anticoagulants, Embolism and Thrombosis, Heart Atria