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September 22, 2023International Archives of Cardiovascular DiseasesOpen Access

Complications of a Giant Left Atrium - Extensive Thrombus Formation Despite Therapeutic Anticoagulation

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Key result

Giant LA in AFib develops extensive thrombi despite therapeutic anticoagulation, requiring surgical removal.

  • n=1

Why the study?

Recurrence of left atrial thrombi is possible despite therapeutic anticoagulation, presenting a risk of thromboembolic stroke or peripheral ischemia.

Design

Case report

Authors

CCC. CharlesRBRai BalajGZGilbert Zachary

Discussion

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Overview

May warrant individualized surgical consideration in refractory giant left atrium cases; leaves open optimal anticoagulation and intervention timing.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P
Population
1 patient (57-year-old female) with a history of bioprosthetic mitral valve replacement, rate-controlled atrial fibrillation s/p dual-chamber pacemaker on warfarin, and nonischemic cardiomyopathy with reduced ejection fraction of 35%, presenting with a giant left atrium and extensive thrombus formation despite therapeutic anticoagulation.
I
Intervention
Redo surgical mitral valve replacement (29 mm Saint Jude medical mechanical heart valve), thrombus removal, left atrial appendage clipping, and left atrial reduction surgery.
O
Outcome
Successful surgical removal of thrombus and mitral valve replacement with improved ejection fraction and weaning off pressors.

Surgical intervention including mitral valve replacement, thrombus removal, and left atrial reduction can be successfully performed in patients with a giant left atrium and extensive thrombus formation despite therapeutic anticoagulation.

Limitations

  • Single case report limits generalizability
  • Research is lacking on the prevalence of thrombi after left atrial reduction surgery

Cite This Study

Charles et al. (2023) conducted a case report in Giant left atrium with extensive thrombus formation and atrial fibrillation (n=1). Surgical mitral valve replacement, thrombus removal, and left atrial reduction was evaluated. A 57-year-old female with a giant left atrium and atrial fibrillation developed extensive left atrial thrombi despite therapeutic anticoagulation, requiring surgical removal and mitral valve replacement.

synapsesocial.com/papers/6a08c8ee865c3eaa9b01e9f3https://doi.org/10.23937/2643-3966/1710058
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Giant left atrium associated with massive thrombus formation2013 · 17 citations
  2. 2Gigantic Thrombus of the Left Atrium in Mitral Stenosis2017 · 6 citations
  3. 3The surgical management of giant left atrium2007 · 127 citations
  4. 4Beyond Ortner’s Syndrome – Unusual Pulmonary Complications of the Giant Left Atrium2005 · 21 citations
  5. 5Atrial enlargement as a consequence of atrial fibrillation. A prospective echocardiographic study.1990 · 754 citations