First Department of Cardioangiology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
International Clinical Research Center (ICRC), St. Anne's University Hospital, Brno, Czech Republic.
BMC Cardiovasc Disord. 2020 Feb 21;20(1):86. doi: 10.1186/s12872-019-01279-1.
Gigantic left atrium is defined in the current literature as an excessive dilatation of the left atrium above 65mm. Chronic mitral valve disease is associated with the development of thrombus in the left atrium in up to 19% of all cases of mitral insufficiency and appropriate treatment must be initiated to prevent thromboembolic events. In order to diagnose thrombi in the left atrium or left atrial appendage, various imaging methods may be used, including cardiac magnetic resonance.
The case report describes a 73-year-old male who developed recurrent sessile thrombus on the posterior wall of the gigantic left atrium. A large thrombus was first detected following mitral valve surgery despite effective vitamin K antagonist anticoagulation therapy. Echocardiography and cardiac magnetic resonance were used within the diagnostic procedure and to monitor the treatment outcomes. Cardiac magnetic resonance was shown to be beneficial as it provided a more precise description of the intra-atrial masses located on the posterior left atrial wall, and in such situations, is of greater benefit than standard echocardiography. This led to the surgical removal of the intra-atrial mass; nevertheless, it was quickly followed by the recurrence of the thrombus. The anticoagulant therapy was adjusted and fortified by the introduction of acetylsalicylic acid and sequentially clopidogrel, but this also did not resolve the thrombus formation. Finally, employing a combination of rivaroxaban and clopidogrel resulted in partial thrombus regression. Therefore, various pathophysiological aspects of thrombus formation and used anticoagulation strategies are discussed.
We describe a unique case of a recurrent thrombus located on the posterior wall of the gigantic left atrium. Cardiac magnetic resonance was shown to be beneficial in providing a more precise description of the intra-atrial masses located on the posterior left atrial wall as compared to standard echocardiographic examination. Development of a thrombus after mitral valve surgery despite effective anticoagulant therapy and its final resolution by introducing a combination of rivaroxaban and clopidogrel highlights the complex etiopathogenesis of thrombus formation. This supports the potential use of this combination in tailoring an individual personalized therapy for patients with recurrent atrial thrombi.
当前文献中定义巨大左心房是指左心房过度扩张，超过 65mm。慢性二尖瓣疾病与高达 19%的二尖瓣关闭不全病例中左心房血栓的形成有关，必须进行适当的治疗以预防血栓栓塞事件。为了诊断左心房或左心耳内的血栓，可能会使用各种成像方法，包括心脏磁共振。
该病例报告描述了一位 73 岁男性，他在巨大左心房的后壁上反复出现无蒂血栓。尽管接受了有效的维生素 K 拮抗剂抗凝治疗，但在二尖瓣手术后首次发现了大量血栓。在诊断过程中以及监测治疗结果时，使用了超声心动图和心脏磁共振。心脏磁共振显示出其优势，因为它可以更准确地描述位于左心房后壁的腔内肿块，在这种情况下，比标准超声心动图更有优势。这导致了对腔内肿块的手术切除，但随后血栓很快再次出现。调整了抗凝治疗方案，引入了乙酰水杨酸和随后的氯吡格雷，但这也没有解决血栓形成问题。最后，采用利伐沙班和氯吡格雷联合治疗导致部分血栓消退。因此，讨论了血栓形成的各种病理生理方面和使用的抗凝策略。
我们描述了一个独特的案例，即巨大左心房后壁反复出现血栓。与标准超声心动图检查相比，心脏磁共振显示出其优势，可以更准确地描述位于左心房后壁的腔内肿块。尽管接受了有效的抗凝治疗，但在二尖瓣手术后仍出现血栓形成，最后通过引入利伐沙班和氯吡格雷联合治疗部分血栓消退，突出了血栓形成的复杂病因。这支持了在为反复出现心房血栓的患者制定个体化治疗方案时，可能会使用这种联合治疗方法。
