A Therapeutic Challenge: Management of Atrial Thrombus

Year 2016, , 278 - 282, 30.12.2016

Serkan Burç Deşer Mustafa Kemal Demirağ

https://doi.org/10.5799/jcei.328366

Abstract

Introduction: Primary cause of atrial thrombi include atrial fibrillation, foreign bodies inside the atrium such as
catheters and pacemaker leads, emboli of deep venous thrombus and primary or metastatic tumors of the heart. We
review the clinical features, epidemiology, diagnosis and treatment of nine intriguing cases with atrial thrombus.
Methods: This is a retrospective study of nine patients (seven female (78%), two male (33%)) who were diagnosed
with atrial thrombi (average age of 50 ± 12 years) and were treated at the Ondokuz Mayis University, Department of
Cardiovascular Surgery from February 2014 to January 2015. Among them, six patients had atrial fibrillation (one
male, five female), seven patients were suffering from dispne and orthopnoea, five patients were suffering from leg
swelling, seven patients had a history of hypertension and three patients had a history of mitral valve replacement
surgery.
Results: All patients underwent surgery except one. Four patients recovered uneventfully and discharged with oral
anticoagulation (warfarin) therapy (adjusted to maintain an international normalized ratio of INR between two and
three times). Five of nine patients (55%) died after surgery.
Conclusion: The response to the thrombolytic therapy is poor, mostly ineffective and unsafe so it is often
recommended as a bridge to surgery. In patients diagnosed with mechanical mitral valve thrombosis, medical therapy
has the possibility of end organ emboli and also fail to resolve the organised thrombus on the stuck valve. On the
other hand surgery does not always give satisfactory results. J Clin Exp Invest 2016; 7(4): 278-282

Keywords

Thrombus, atrium, treatment

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