Mobile biatrial thrombus in a patient with mitral stenosis under heparin infusion
Kutay Tasdemir 1,
Bahadir Sarli 1,
Mehmet G. Kaya 1*,
Ozgur Gunebakmaz 1
1 Erciyes University School of Medicine, Kayseri, Turkey
* To whom correspondence should be addressed. E-mail: drmgkaya{at}yahoo.com.
 |
Abstract |
|---|
A 58-year-old female patient with complaints of sudden presenting pain and pallor on her left foot was referred to our clinic for urgent embolectomy. On her cardiovascular examination there was an apical grade 2/6 systolic murmur and a grade 2/4 diastolic murmur. The presenting electrocardiography revealed atrial fibrillation with rapid ventricular response. She underwent emergent femoro-popliteal embolectomy. Transthorasic echocardiography showed a mobile 1.4x1.7 cm sized left atrial thrombus, mild mitral regurgitation and 9 mmHg mean gradient on mitral valve after embolectomy. Unfractioned (UF) heparin infusion was initiated immediately after surgery. After 3 days the control transthoracic echocardiography revealed left atrial thrombus and also a large 'snake-like' thrombus waving in right atrium. The patient underwent biatrial thrombecthomy and mitral valve replacement. When she became heamodynamically stable, bilateral lower limb venous Doppler ultrasonographic study was performed. This study indicated a thrombus formation in the deep veins of the left leg. The origin of the right atrial thrombus was probably a snapped piece of thrombus from the calf deep-veins after the initiation of intravenous UF heparin. In summary, we have reported an extremely rare case of biatrial thrombus in a patient under UF heparin infusion. Keywords: Mitral stenosis; Thrombus; Heparin
