Tasdemir Kutay, Sarli Bahadir, Kaya Mehmet G, Gunebakmaz Ozgur
Department of Cardiovascular Surgery, Erciyes University School of Medicine, 38039 Kayseri, Turkey.
Interact Cardiovasc Thorac Surg. 2008 Aug;7(4):667-9. doi: 10.1510/icvts.2008.179093. Epub 2008 May 16.
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. Transthoracic echocardiography showed a mobile 1.4 x 1.7-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 three days, the control transthoracic echocardiography revealed left atrial thrombus and also a large 'snake-like' thrombus waving in right atrium. The patient underwent biatrial thrombectomy and mitral valve replacement. When she became haemodynamically stable, a 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.
一名58岁女性患者因左脚突发疼痛和苍白被转诊至我院进行紧急取栓术。心血管检查发现心尖部有2/6级收缩期杂音和2/4级舒张期杂音。心电图显示房颤伴快速心室率。她接受了急诊股-腘动脉取栓术。经胸超声心动图显示左心房有一个活动的1.4×1.7厘米大小的血栓，取栓术后二尖瓣轻度反流，二尖瓣平均压差为9毫米汞柱。术后立即开始输注普通肝素。三天后，经胸超声心动图复查发现左心房血栓，右心房还有一个大的“蛇形”血栓在飘动。患者接受了双心房血栓切除术和二尖瓣置换术。当她血流动力学稳定后，进行了双下肢静脉多普勒超声检查。该检查显示左腿深静脉有血栓形成。右心房血栓的来源可能是静脉输注普通肝素后小腿深静脉的血栓碎片脱落。总之，我们报告了一例在输注普通肝素的患者中极为罕见的双心房血栓病例。
