Hargiyanto Erlangga Diasmara, Dewi Ivana Purnama, Dharmadjati Budi Baktijasa
Faculty of Medicine, Airlangga University, Surabaya, Indonesia.
Department of Cardiology and Vascular Medicine, Dr. Soetomo General Hospital, Surabaya, Indonesia.
Ann Med Surg (Lond). 2022 Aug 6;80:104328. doi: 10.1016/j.amsu.2022.104328. eCollection 2022 Aug.
Valvular heart disease is highly prevalent, especially in developing countries. Mitral Stenosis (MS) is a condition where there is narrowing of mitral heart valve. Left atrial (LA) thrombus is often seen in severe MS patients.
A 47-year-old woman complained of palpitation and shortness of breath. The heart sounded irregularly irregular, with grade III/IV diastolic murmurs at the apex. Her electrocardiogram showed atrial fibrillation (AF) with rapid ventricular response Transthoracal echocardiography (TTE) showed severe MS, mild tricuspid regurgitation, and LA thrombus. Mitral valve replacement surgery, tricuspid valve repair, and evacuation of the LA thrombus were immediately done. We evacuated a spherical mass with a size of 4 × 3x2.2 cm, layered and easily separated. Microscopic examination showed extensive fibrin and bleeding with mononuclear inflammatory cells and macrophages, corresponding to a thrombus conclusion.
Atrial thrombus is common in MS patients. The incidence will increase by about two times in patients with AF. TTE is a reliable tool in diagnosing large mobile atrial thrombus and differentiated it from other cardiac masses. However, histopathological examination is still the gold standard to distinguish between LA thrombus and myxoma. Immediate thrombus evacuation and valve replacement, if needed, will give good results and reduce systemic thromboembolism.
LA thrombus is often seen in a patient with severe MS. Optimal preoperative preparation involves assessing preoperative risk stratification will give good results.
心脏瓣膜病非常普遍，尤其是在发展中国家。二尖瓣狭窄（MS）是一种二尖瓣心脏瓣膜狭窄的病症。重度MS患者中常可见左心房（LA）血栓形成。
一名47岁女性主诉心悸和呼吸急促。心脏听诊心律绝对不齐，心尖部有III/IV级舒张期杂音。她的心电图显示房颤（AF）伴快速心室反应。经胸超声心动图（TTE）显示重度MS、轻度三尖瓣反流和LA血栓。立即进行了二尖瓣置换手术、三尖瓣修复及LA血栓清除术。我们清除了一个大小为4×3×2.2 cm的球形肿物，呈分层状且易于分离。显微镜检查显示广泛的纤维蛋白、出血，伴有单核炎性细胞和巨噬细胞，符合血栓诊断结果。
心房血栓在MS患者中很常见。房颤患者的发生率会增加约两倍。TTE是诊断大型可移动心房血栓并将其与其他心脏肿物区分开来的可靠工具。然而，组织病理学检查仍是区分LA血栓和黏液瘤的金标准。如有必要，立即进行血栓清除和瓣膜置换将取得良好效果并减少全身血栓栓塞。
重度MS患者常可见LA血栓。进行术前风险分层评估的最佳术前准备将取得良好效果。
