Key result
Anticoagulation discontinuation after mitral valve replacement linked to rare left atrial ball and appendage thrombi.
Why the study?
Free-floating ball-shaped thrombus is a rare echocardiographic finding in patients with mitral valve disease, especially with concomitant appendage thrombi.
Case Report (n=1)
Free-floating ball-shaped thrombus is a rare echocardiographic finding in patients with mitral valve disease, especially when coexisting with appendage thrombi.
Persistent free-floating atrial thrombi may persist despite anticoagulation in mitral valve disease; this case leaves open questions on optimal management.
We reported a 67-year-old woman in whom large atrial thrombi were found by chance during discontinuation of therapeutic anticoagulation. The patient, with a history of mitral valve replacement surgery, had stopped anticoagulation for months because of intractable gastrointestinal bleeding, during which she was found to have 3 large thrombi in the atria on transesophageal echocardiography: left atrial free-floating ball-shaped thrombus, left atrial appendage thrombus, and right atrial appendage thrombus. One month following diagnosis, she still had the free-floating thrombus despite adequate anticoagulation. Free-floating ball-shaped thrombus is a rare finding observed on echocardiography in patients with mitral valve disease and an even rarer finding in case of appendage thrombi coexisting.
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Akamatsu et al. (2019) conducted a case report in Atrial thrombi (n=1). Discontinuation of therapeutic anticoagulation was evaluated. Discontinuation of anticoagulation in a woman with prior mitral valve replacement led to the rare formation of a left atrial ball-shaped thrombus and biatrial appendage thrombi.
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