Department of Cardiovascular Surgery, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.
Ann Thorac Surg. 2013 Dec;96(6):2236-8. doi: 10.1016/j.athoracsur.2013.01.099.
The patient was a 72-year-old man with left hemiparesis. Multiple hemorrhagic cerebral infarctions were recognized on a computed tomographic (CT) scan. A transesophageal echocardiogram showed a huge left atrial mass, which was floating and nearly obstructed the mitral orifice in the diastolic phase. Emergency left atrial mass removal was performed. To reduce the risk of critical brain hemorrhage, the dose of heparin was reduced (100 U/kg) and 1 mg/kg/h of nafamostat mesilate was administered into the venous circuit during extracorporeal circulation. A postoperative brain CT scan showed no evidence of deterioration of cerebral hemorrhage. Pathologic examination showed a ball thrombus.
患者为 72 岁男性，左侧偏瘫。头颅 CT 扫描发现多发出血性脑梗死。经食管超声心动图显示巨大的左房血栓，呈漂浮状，几乎在舒张期阻塞二尖瓣口。紧急行左房血栓切除术。为降低脑出血的风险，减少肝素剂量（100 U/kg），体外循环期间静脉回路中给予 1 mg/kg/h 的甲磺酸萘莫司他。术后头颅 CT 扫描未见脑出血恶化的证据。病理检查显示球形血栓。
