Nosaka S, Nakayama K, Yamanouchi M, Gu K, Sasaki T, Saito Y, Tamura K
First Department of Surgery, Shimane Medical University, Izumo, Japan.
Kyobu Geka. 1995 Oct;48(11):960-2.
A 77-year-old man who had a left atrial free-floating ball thrombus without mitral valve disease was operated. His electrocardiogram showed atrial fibrillation. Transesophageal echocardiography showed free-floating mass in dilated left atrium and intact mitral valve. Transesophageal echocardiogram was also useful for intra-operative management. At the operation, the mass proved to be a free-floating ball thrombus in the left atrium and the intact mitral valve was confirmed. The thrombus was removed, but we could not wean the patient from extra-corporeal circulation due to intra-operative myocardial infarction. Autopsy showed left ventricular hypertrophy and the focus of acute myocardial infarction in lateral wall and posterior wall of left ventricle. Furthermore, large organized thrombi were found in aorta and right main pulmonary artery. It was suggested that the patient had abnormal coagulative system or fibrolytic system preoperatively.
一名77岁男性，无二尖瓣疾病但左心房有游离球状血栓，接受了手术治疗。他的心电图显示为房颤。经食管超声心动图显示扩张的左心房内有游离肿块，二尖瓣完整。经食管超声心动图对术中管理也很有用。手术中，肿块被证实为左心房内的游离球状血栓，二尖瓣完整得到确认。血栓被清除，但由于术中发生心肌梗死，患者无法脱离体外循环。尸检显示左心室肥厚，左心室侧壁和后壁有急性心肌梗死灶。此外，在主动脉和右主肺动脉发现了大量机化血栓。提示患者术前存在凝血系统或纤溶系统异常。
