Right atrial appendage thrombosis in atrial fibrillation: its frequency and its clinical predictors

Divitiis, Marcello de; Omran, Heyder; Rabahieh, Rami; Rang, Barbara; Illien, Stefan; Schimpf, Rainer; MacCarter, Dean; Jung, Werner; Becher, Harald; Lüderitz, Berndt

doi:10.1016/s0002-9149(99)00492-0

Cited by 74 publications

(72 citation statements)

References 26 publications

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“…5 It is widely known that RAA function is impaired in cases of AF, which is associated with thrombus formation. 6 In the present case, there was an immobile, clot-like thrombus in the RAA. Therefore, AF can be considered to be the cause of thrombi in both atria.…”

Section: Images In Cardiovascular Medicine Triple-chamber Cardiac Thrsupporting

confidence: 43%

Triple-Chamber Cardiac Thrombosis in a Patient With Atrial Fibrillation and Severe Left Ventricular Dysfunction

Nishigawa

Takiuchi

Kubo

et al. 2011

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp 74-year-old man with a history of hypertension was admitted for further examination of worsening exertional dyspnea. On admission, his heart rate was 140 beats/min and the rhythm was irregular. An ECG showed atrial fibrillation (AF) and chest X-ray revealed increased cardiothoracic ratio, with pulmonary congestion and bilateral pleural effusion. Transthoracic echocardiography (TTE) demonstrated a large mural thrombus in the left ventricular (LV) apex and severe LV dysfunction, with fractional shortening of 11% and diffuse, severe hypokinetic wall motion ( Figure 1A). Moderate mitral regurgitation (MR), because of leaflet tethering, and enlarged atria were also detected. A small mass lesion detected in the right atrium (RA) was considered to be a thrombus. Because the patient was not taking any medication other than antihypertensive drugs, administration of diuretics and anticoagulant drugs was promptly initiated. Laboratory data showed normal levels of proteins C and S, and negative antiphospholipid antibodies. Follow-up TTE (3 days later) revealed that the thrombus in the LV apex had become a 20×16 mm mobile thrombus, and the mass lesion in the RA had increased in size to 22×22 mm ( Figure 1B). Coronary angiography showed a normal coronary artery. He was referred for surgical treatment of the mobile thrombus in the LV apex and the mass lesion in the RA. Post-induction transesophageal echocardiography detected the thrombus in the left atrial appendage (LAA) (Figure 2 IMAGES IN CARDIOVASCULAR MEDICINE

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Section: Images In Cardiovascular Medicine Triple-chamber Cardiac Thrsupporting

confidence: 43%

Triple-Chamber Cardiac Thrombosis in a Patient With Atrial Fibrillation and Severe Left Ventricular Dysfunction

Nishigawa

Takiuchi

Kubo

et al. 2011

Circ J

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“…In a study, spontane ous echo contrast was observed in all patients in atrial fibrillation with associated intracardiac thrombi. 9 Index patient developed thrombosis in the absence of atrial fibrillation, most probably because of the venous stasis caused by the constrictive physiology and narrowing of tricuspid valve annulus and adjacent RV free wall due to constriction band formed by thickened pericardium around atrioventricular groove. Right heart thrombi detected on echocardiography are of two types.…”

Section: Discussionmentioning

confidence: 99%

Modification in Surgical Plan following Intraoperative Detection of Co-existent Right Atrial Thrombus by Transesophageal Echocardiography in Chronic Constrictive Pericarditis

Mahajan¹,

Ganesan²

2017

Journal of Perioperative Echocardiography

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Introduction Chronic constrictive pericarditis (CCP) is common in developing countries, tuberculosis being the most common cause. Dyspnea and congestive symptoms are the most common nonspecific presenting symptoms that require further evaluation for clinching the diagnosis. Coexistent right atrial (RA) thrombus and CCP are rare occurrences. Preoperative detection of RA thrombus is very important to avoid the risk of pulmonary thromboembolism during pericardiectomy or cannulation for establishing cardiopulmonary bypass (CPB). Perioperative echocardiography may play a crucial role in this setting. We report a case of CCP in which preoperative transesophageal echocardiography (TEE) detected RA thrombus that led to change in surgical plan and provided continuous monitoring during surgery. Case Report A 14-year-old male presented with a history of abdominal distension and pedal edema for 5 months. Physical examination revealed raised jugular venous pulse with normal heart sounds and no murmurs. Transthoracic echocardiography (TTE) revealed constrictive physiology and thickened pericardium. After induction of anesthesia, TEE revealed an irregular hyperechoic mass (50 × 36 × 30 mm) in the RA free wall that was not detected on preoperative TTE and computerized tomography (CT). Thickened pericardium all around mandated limited pericardiectomy under TEE guidance to allow bicaval cannulation for establishing CPB. This was followed by surgical removal of the thrombus and remaining pericardiectomy using CPB. His postoperative period was uneventful and the patient was discharged home on postoperative day 7. Conclusion The TEE may be instrumental in diagnosis of coexistent RA thrombus in the case of CCP resulting in major change in surgical plan and providing perioperative monitoring to avert significant morbidity and mortality. How to cite this article Ganesan R, Kumar B, Munirathinam GK, Bhat I, Mahajan S. Modification in Surgical Plan following Intraoperative Detection of Co-existent Right Atrial Thrombus by Transesophageal Echocardiography in Chronic Constrictive Pericarditis. J Perioper Echocardiogr 2017;5(1):34-37.

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“…The study by de Divitiis et al [59] revealed higher values of the area of the RA and a maximum area of the RAA and lower fractional area change and emptying velocities of the RAA in patients with AF compared to SR. Similar changes were also found in patients with thrombosis of the RAA compared to its absence.…”

Section: Right Atrial Appendagementioning

confidence: 91%

“…In various studies, the incidence of SEC and thrombi in the RA and its appendage in patients with AF ranged between 1-7.5% and 10-57% [56][57][58][59]. Although systemic thromboembolism risk is mostly studied, pulmonary embolism is also possible in patients with AF.…”

Section: Right Atrial Appendagementioning

confidence: 99%

Contemporary echocardiographic assessment of atrial appendages in non-valvular atrial fibrillation

Lohvinov

Mikhaliev²,

Zharinov

2015

Kardiol Pol

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Right atrial appendage thrombosis in atrial fibrillation: its frequency and its clinical predictors

Cited by 74 publications

References 26 publications

Triple-Chamber Cardiac Thrombosis in a Patient With Atrial Fibrillation and Severe Left Ventricular Dysfunction

Triple-Chamber Cardiac Thrombosis in a Patient With Atrial Fibrillation and Severe Left Ventricular Dysfunction

Modification in Surgical Plan following Intraoperative Detection of Co-existent Right Atrial Thrombus by Transesophageal Echocardiography in Chronic Constrictive Pericarditis

Contemporary echocardiographic assessment of atrial appendages in non-valvular atrial fibrillation

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