Dedeilias Panagiotis, Roussakis Antonios, Koletsis Efstratios N, Zervakis Dimitrios, Hountis Panagiotis, Prokakis Christos, Balaka Christina, Bolos Konstantinos
Cardiothoracic Surgery Department, University of Patras, Greece.
J Cardiothorac Surg. 2008 Apr 23;3:18. doi: 10.1186/1749-8090-3-18.
Left atrial thrombi are mostly related to mitral valve disease. The differential diagnosis of clots and myxomas in the left atrium is mostly based on echocardiography. Infection of intracardiac thrombi is extremely rare and mostly reported in ventricular clots or aneurysms following myocardial infarction.
We present the case of a 65 year old female with a history of mitral valve disease and chronic atrial fibrillation who suffered repeated embolic strokes and a giant infected clot in the left atrium. Although the patient underwent prompt surgery with removal of the clot and valve replacement the complication of septic emboli to the CNS led her to death. To the best of our knowledge this is the second report of an infected left atrial thrombus.
The case is a representative example of a neglected and undertreated patient with catastrophic consequences. Anticoagulant therapy in patients with mitral valve disease and atrial fibrillation should be applied according the currently available guidelines and standards in order to avoid analogous paradigms in the future. Mitral valve substitution should be considered in patients with mitral valve disease presenting thromboembolic complications. Surgery should be considered as the treatment of choice in cases of organized left atrial thrombus and suspected tumor or infected mass.
左心房血栓大多与二尖瓣疾病有关。左心房内血栓与黏液瘤的鉴别诊断主要基于超声心动图。心内血栓感染极为罕见，大多报道于心肌梗死后的心室血栓或室壁瘤。
我们报告一例65岁女性患者，有二尖瓣疾病和慢性心房颤动病史，反复发生栓塞性卒中，左心房有巨大感染性血栓。尽管患者接受了及时手术，清除了血栓并进行了瓣膜置换，但中枢神经系统脓毒性栓子并发症导致其死亡。据我们所知，这是第二例关于感染性左心房血栓的报告。
该病例是一个被忽视且治疗不足、导致灾难性后果患者的典型例子。二尖瓣疾病和心房颤动患者应根据当前可用的指南和标准进行抗凝治疗，以避免未来出现类似情况。二尖瓣疾病出现血栓栓塞并发症的患者应考虑二尖瓣置换术。对于有组织的左心房血栓以及疑似肿瘤或感染性肿块的病例，应考虑手术作为首选治疗方法。
