Successful anticoagulation therapy for a giant left atrial thrombus following mitral valve repair

Abstract

A 72-year-old male with atrial fibrillation (AF) underwent mitral valve (MV) repair and concomitant procedures. He was discharged with therapeutic Warfarin dosing but was readmitted 3 weeks later with a right caudate nucleus infarct and subtherapeutic anticoagulation. Echocardiography showed a giant left atrial (LA) thrombus. Low-molecular-weight heparin was promptly initiated. Unfortunately, the patient suffered an intracranial hemorrhage (ICH) 2 days later. He declined surgical thrombectomy and was managed conservatively, remaining stable without neurological deficits. Serial brain imaging showed interval stability, allowing Warfarin to be resumed. Follow-up echocardiography demonstrated partial and complete resolution of the thrombus at 1 and 3 months, respectively.

Role of Cardiac Magnetic Resonance in Diagnosis and Treatment of Ball Thrombus in Left Atrium – Trust But Verify! – Case Report

“…The treatment options of intracardiac thrombi are still a challenge [4,10] because of the embolization risk, the presence of malignancy and the patient's preference. In our case CMR clearly excluded the presence of free-floating or organized ball thrombus and malignancy that would require surgical removal.…”

“…Once accurate diagnosis of the thrombus is clearly established the race for treatment starts. Both the risk and benefits from surgical and conservative treatment must be weighed for each patient individually [1,2,3,4].…”