Ando S, Inoue K, Tanaka H, Narisawa T, Yamada M, Takaba T
Department of Surgery, Showa University Medical School, Tokyo, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1996 Jun;44(6):858-63.
Occurrence of thrombus formation in the left atrium is rare without accompanying abnormalities at the mitral valve. Only a few cases of giant and pedunculated thromboses in the left atrium have been reported in the Japanese literatures. This is a case report of giant thrombus in the left atrium treated surgically. Patient was 61 years old male suffering from palpitation. Physical examination of the heart revealed increased first sound and diastolic rumbling at the apex. ECG revealed atrial fibrillation and LVH. Echocardiography and chest CT demonstrated a huge tumor like mass in the left atrium attached to the septal area. There were no abnormalities found at mitral valvular structures or motion. Catheterization studies revealed no disturbance of valvular functions. Angiographic examination demonstrated smooth surfaced tumor mass occupied left atrium. Coronary angiography revealed significant stenosis in segments 6, 7, 9, 12 and 14. Prior to surgery, patient was diagnosed myxoma of the left atrium and ischemic heart disease. Removal of the mass and CABG were carried out at a same time. Pathology revealed giant and pedunculated globular thrombus. Contributional factors possibly growing of such huge thrombus formation explained resulting from atrial fibrillation and decreased contractile force of the hypertrophied ventricle.
在没有二尖瓣伴随异常的情况下，左心房形成血栓的情况很少见。日本文献中仅报道了少数几例左心房巨大带蒂血栓的病例。这是一例接受手术治疗的左心房巨大血栓的病例报告。患者为61岁男性，有心悸症状。心脏体格检查发现心尖第一心音增强及舒张期隆隆样杂音。心电图显示房颤及左心室肥厚。超声心动图和胸部CT显示左心房内有一个巨大的肿瘤样肿块附着于房间隔区域。二尖瓣结构及活动未见异常。心导管检查显示瓣膜功能无异常。血管造影检查显示表面光滑的肿瘤样肿块占据左心房。冠状动脉造影显示6、7、9、12和14段有明显狭窄。手术前，患者被诊断为左心房黏液瘤和缺血性心脏病。同时进行了肿块切除和冠状动脉旁路移植术。病理检查显示为巨大带蒂球形血栓。这种巨大血栓形成可能的促成因素解释为房颤和肥厚心室收缩力下降。
