Key result
A fresh thrombus formed in the left atrial appendage during cardiopulmonary bypass despite full heparinization and an activated clotting time > 500 seconds.
Case Report (n=1)
No
Adequate activated clotting time during cardiopulmonary bypass does not guarantee suppression of thrombus formation, highlighting the critical role of comprehensive intraoperative transesophageal echocardiography.
Thrombus may form despite ACT >500 s on bypass; this case report leaves open whether routine TEE monitoring is warranted.
We reports a case of a newly formed thrombus in the left atrial appendage during cardiopulmonary bypass detected by transesophageal echocardiography in a patient with chronic atrial fibrillation and mitral stenosis. This case alerts the anesthesiologists of possible thrombus formation despite full heparinization during cardiac surgery and the importance of a comprehensive echocardiography examination.
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Kim et al. (2012) conducted a case report in Mitral stenosis and atrial fibrillation (n=1). Cardiopulmonary bypass with full heparinization was evaluated on Thrombus formation. A fresh thrombus formed in the left atrial appendage during cardiopulmonary bypass despite full heparinization and an activated clotting time > 500 seconds.
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