Key result
Despite surgical removal of a giant E. coli-infected left atrial thrombus and mitral valve replacement, the patient died from complications of septic emboli to the central nervous system.
Case Report (n=1)
This case highlights the rare but catastrophic complication of an infected left atrial thrombus in a patient with mitral valve disease and atrial fibrillation, emphasizing the critical need for guideline-directed anticoagulation.
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Fatal septic emboli despite surgery for infected left atrial thrombus; hypothesis-generating for prevention in mitral disease with AF.
BACKGROUND: Left atrial thrombi are mostly related to mitral valve disease. The differential diagnosis of clots and myxomas in the left atrium is mostly based on echocardiography. Infection of intracardiac thrombi is extremely rare and mostly reported in ventricular clots or aneurysms following myocardial infarction. CASE PRESENTATION: We present the case of a 65 year old female with a history of mitral valve disease and chronic atrial fibrillation who suffered repeated embolic strokes and a giant infected clot in the left atrium. Although the patient underwent prompt surgery with removal of the clot and valve replacement the complication of septic emboli to the CNS led her to death. To the best of our knowledge this is the second report of an infected left atrial thrombus. CONCLUSION: The case is a representative example of a neglected and undertreated patient with catastrophic consequences. Anticoagulant therapy in patients with mitral valve disease and atrial fibrillation should be applied according the currently available guidelines and standards in order to avoid analogous paradigms in the future. Mitral valve substitution should be considered in patients with mitral valve disease presenting thromboembolic complications. Surgery should be considered as the treatment of choice in cases of organized left atrial thrombus and suspected tumor or infected mass.
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Dedeilias et al. (2008) conducted a case report in Left atrial giant thrombus infected by Escherichia Coli (n=1). Surgical removal of clot and mitral valve replacement was evaluated on Clinical outcome. Despite surgical removal of a giant E. coli-infected left atrial thrombus and mitral valve replacement, the patient died from complications of septic emboli to the central nervous system.
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