Key result
De novo LAA thrombus develops during cardiopulmonary bypass weaning despite sinus rhythm and adequate heparinization.
Why the study?
De novo left atrial appendage thrombus formation during cardiopulmonary bypass weaning is rare but potentially catastrophic and not well characterized.
Case Report (n=1)
No
Systematic TEE reassessment during cardiopulmonary bypass weaning is crucial for early detection of potentially catastrophic de novo left atrial appendage thrombus, even in patients with sinus rhythm and seemingly adequate heparinization.
May warrant TEE vigilance during prolonged CPB weaning; hypothesis-generating for de novo LAA thrombus risk in sinus rhythm.
Left atrial appendage (LAA) thrombus formation during cardiac surgery is rare but poten-tially catastrophic because of the risk of systemic embolization and perioperative stroke.We report a 61-year-old man with hypertension, diabetes, heart failure, and severe coro-nary artery disease who underwent redo Bentall operation for paravalvular leakage after a prior aortic valve replacement.He was in sinus rhythm, and pre-bypass transesophageal echocardiography (TEE) showed no LAA thrombus.Heparin achieved an activated clot-ting time of 511 s; cardiopulmonary bypass (CPB) and cross-clamp times were 342 and 312 min under moderate hypothermia.During the weaning from CPB, TEE incidentally detected a new LAA thrombus.Partial LAA ligation and thrombus removal were per-formed; residual mural thrombus remained, but no embolism or neurologic deficit oc-curred.Follow-up transthoracic echocardiography showed no residual thrombus by postoperative day 7 and 20.Routine coagulation tests and a limited thrombophilia evalu-ation were unremarkable, while the initially suspected diagnosis of Behçet disease was not supported by established classification criteria.Prolonged CPB with transient low-flow conditions and pre-existing left atrial enlargement may have promoted local blood stasis and contributed to thrombus formation.This case highlights that de novo LAA thrombus can develop during CPB weaning despite adequate systemic hepariniza-tion and apparently adequate activated clotting time (ACT), even in a patient without atrial fibrillation or mitral stenosis.Systematic TEE reassessment during CPB weaning may facilitate early recognition and prompt management of this rare complication.
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Yoo et al. (2026) conducted a case report in Paravalvular leakage requiring redo Bentall operation (n=1). Prolonged cardiopulmonary bypass was evaluated on De novo left atrial appendage thrombus formation. De novo left atrial appendage thrombus developed during weaning from prolonged cardiopulmonary bypass in a patient with sinus rhythm despite adequate systemic heparinization.
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