Key result
Six months of warfarin resolves recurrent LA thrombus post-maze procedure in a single patient.
Case Report (n=1)
No
This case highlights the potential for left atrial thrombus recurrence after surgical excision and maze procedure, which can be successfully managed with warfarin therapy.
May support targeted warfarin use for recurrent post-maze LA thrombus; leaves open need for prospective confirmation.
A 67-year-old woman developed weakness of the entire left side of the body and disturbance of consciousness, and was admitted to our hospital. She had atrial fibrillation (AF) on arrival at the hospital. Diffusion weighted magnetic resonance imaging showed high intensity area in the right basal ganglia, and magnetic resonance angiography showed occlusion of the right internal carotid artery (ICA). Thrombolytic therapy with intravenous tissue plasminogen activator (IV tPA) was administered 225 minutes after onset, and endovascular procedure also performed. After endovascular therapy, the patient had successful recanalization of the right ICA. Transesophageal echocardiography (TEE) showed a mass in the left atrium. Cardiac surgery for the excision of a left atrial mass and the maze procedure for atrial fibrillation were performed on the 29th hospital day. The mass was pathologically confirmed as thrombus. Follow up TEE after cardiac surgery revealed recurrence of thrombus at the both origin of pulmonary vein in the left atrium. Finally, the thrombus was disappeared at 6-month after onset with taking warfarin. She had no stroke events during the clinical course.
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Arakawa et al. (2017) conducted a case report in Cerebral embolism, left atrial thrombus, atrial fibrillation (n=1). IV tPA, endovascular therapy, cardiac surgery (mass excision and maze procedure), and warfarin was evaluated on Clinical course and thrombus resolution. In a 67-year-old woman with cerebral embolism, a left atrial thrombus recurred at the pulmonary vein origins after the maze procedure but completely disappeared after 6 months of warfarin therapy.
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