Sabri Muhammad Salman, Weber Carly, Belkadi Yanis, Haas Donald, Rajeswaran Yasotha
Department of Internal Medicine, Jefferson Abington Hospital, Abington, Pennsylvania, USA.
Department of Cardiology, Lehigh Valley Hospital-Cedar Crest, Allentown, Pennsylvania, USA.
JACC Case Rep. 2025 Sep 3;30(26):104884. doi: 10.1016/j.jaccas.2025.104884.
Atrial fibrillation or flutter in rheumatic mitral stenosis (MS) increases left atrial appendage (LAA) thrombus risk despite therapeutic anticoagulation.
A 72-year-old woman on warfarin with moderate MS and atrial flutter presented with dyspnea. Transesophageal echocardiogram (TEE) showed a large LAA thrombus despite an international normalized ratio >2.5. Cardioversion was deferred, and the international normalized ratio target was raised to a range of 2.5 to 3.5.
TAKE-HOME MESSAGES: While cardioversion can be considered in patients with uninterrupted anticoagulation without TEE, those with rheumatic MS are at high risk of LAA and LA thrombus and should undergo TEE before the procedure. Further research is needed to explore whether LAA thrombus warrants surgical intervention for rheumatic MS.
风湿性二尖瓣狭窄（MS）患者即使接受治疗性抗凝，房颤或房扑仍会增加左心耳（LAA）血栓形成风险。
一名72岁服用华法林的女性，患有中度MS和房扑，出现呼吸困难。经食管超声心动图（TEE）显示尽管国际标准化比值>2.5，但仍存在较大的LAA血栓。心脏复律被推迟，国际标准化比值目标提高到2.5至3.5的范围。
虽然在未进行TEE且抗凝未中断的患者中可考虑心脏复律，但风湿性MS患者发生LAA和左心房（LA）血栓的风险很高，应在手术前进行TEE检查。需要进一步研究以探讨LAA血栓是否需要对风湿性MS进行手术干预。
