[A case of left atrial thrombi following mitral valvuloplasty for mitral regurgitation associated with idiopathic thrombocytopenic purpura].

A 58-year-old man, who had been submitted to an indication of mitral valvuloplasty (MVP) because of severe mitral regurgitation, was diagnosed as idiopathic thrombocytopenic purpura (ITP). In order to diminish the peri-operative blood loss, splenectomy and high-dose bolus administration of gamma-globulin (400 mg/kg/day) were performed at the time of two weeks and during last five days respectively, prior to MVP surgery. In early post-operative stage, anticoagulant therapy was held down considering ITP, and we were not troubled with bleeding throughout the peri-operative period. On the fourteenth post-operative day, however, mural thrombi in the left atrium were pointed out by transesophageal echocardiography (TEE). Then anticoagulant therapy was reinforced by increasing the warfarin dose. When TEE was restudied on 36th, post-operative day, mural thrombi had almost disappeared. Although it is commonly known that mitral valvuloplasty has low risk of thrombosis and less necessity of anticoagulation, hyper coagulability may be feasible in the early post-operative period of our case whose ITP is meticulously treated prior to surgery. Suitable anticoagulation should have been performed regardless of ITP immediately after MVP.