Department of Anesthesiology, Queen's University, Kingston, Ontario, Canada.
J Am Soc Echocardiogr. 2010 Sep;23(9):1008.e1-3. doi: 10.1016/j.echo.2010.03.010. Epub 2010 Apr 18.
Left atrial appendage (LAA) thrombus is a common finding in patients with atrial fibrillation and a major source of emboli that cause strokes. The incidental finding of an LAA thrombus during cardiac surgery is an infrequent finding during routine intraoperative echocardiography, and optimal management is not well defined. A case of a large, incidentally discovered LAA thrombus that became mobile on initiation of cardiopulmonary bypass in a patient undergoing coronary artery bypass graft surgery is presented. Intraoperative transesophageal echocardiography diagnosed the thrombus, discovered its dislodgement from the LAA, and very interestingly demonstrated its surgical removal. This case demonstrates the ability of intraoperative transesophageal echocardiography to alter surgical management and provides support for its routine use in cases in which LAA thrombi are likely.
左心耳（LAA）血栓是心房颤动患者的常见发现，也是导致中风的栓子的主要来源。在心脏手术期间偶然发现 LAA 血栓是术中常规经食管超声心动图检查中不常见的发现，其最佳治疗方法尚未明确。本文报道了 1 例在接受冠状动脉旁路移植术的患者中，体外循环开始时偶然发现的大而移动的 LAA 血栓。术中经食管超声心动图诊断了血栓，发现其从 LAA 脱落，并非常有趣地显示了其手术切除。该病例表明术中经食管超声心动图有改变手术管理的能力，并为在可能存在 LAA 血栓的情况下常规使用提供了支持。
