Acute Lower Extremity Embolism Resulting in Rheumatic Mitral Stenosis: A Case Report

Year 2015, Volume: 22 Issue: 4, 272 - 273, 15.12.2015

Atalay Karakaya Serdar Menekşe Özgür Bulut

Abstract

A 52-year-old woman was admitted with sudden onset of acute arterial occlusion in the right lower limb. We found 3-4/6 diastolic murmur and, in the ECG, rapid ventricular response in atrial fibrillation. The patient underwent an emergency operation. We applied transthoracic and transesophageal echocardiography to investigate the etiology of thromboembolism and diagnosed the patient with mitral stenosis. The patient was recommended for a mitral valve surgery. Preoperative coronary angiography revealed a normal picture. The mitral valve was resected in the operation. We also performed carbon-coated bileaflet prosthetic valve replacement. The left atrial appendix was ligated. The patient did not have any postoperative clinical problems. Having recommended appropriate medical treatment, the patient was discharged. In conclusion, thromboembolism and atrial fibrillation in patients with rheumatic heart diseases should be kept in mind throughout the diagnosis process.

Keywords: Thromboembolism; Mitral Stenosis; Atrial Fibrillation.

Keywords

-

Journal of Turgut Ozal Medical Center

Abstract

Elliiki yaşında bayan hasta sağ alt extremitede ani başlayan akut arteriel tıkanıklık bulgusu ile yatırıldı. Mitral dinleme odağında 3-4/6 diastolik üfürüm ve elektrokardiografisinde hızlı ventrikül yanıtlı atrial fibrilasyon tesbit edildi. Acil ameliyata alındı. Tromboemboli etiyolojisini araştırmak amacıyla yapılan transtorasik ve transözefageal ekokardiografisinde mitral stenoz tesbit edildi. Hastaya mitral kapak cerrahisi önerildi. Ameliyat öncesi yapılan koroner anjiografisinde koronerler normal olarak saptandı. Operasyonda mitral kapak çıkartılarak karbon kaplı bileaflet protez kapak ile replasman yapıldı. Sol atrial apendix bağlandı. Operasyon sonrası klinik problem yaşanmadı. Uygun medikal tedavi düzenlenerek hasta taburcu edildi. Sonuç olarak kliniği tromboemboli ile ortaya çıkan ve atrial fibrilasyonu olan hastalarda romatizmal kalp hastalığı akılda tutulmalıdır

Keywords

Tromboemboli, Mitral Stenoz, Atrial Fibrilasyon

References

• Constantini V, Lent. M. Treatment of acuteocclusion of peripheral arteries. Thromb Res 2002;106(6):285-94.
• AbuRahma AB, Richmond BK, Robinson PA. Etiology of peripheral arteriel thromboembolism in young patients. Am J Surg 1998;176(2):158-61.
• Baxter-Smith D,Ashton F, Slaney G. Peripheral arteriel embolism. A 20 year rewiew. J Cardiovasc Surg 1998;29(4):453-7.
• Mutirangura P, Ruangsetakit C, Wongwanit C, Sermsathanasawadi N, Chinsakchai K. Clinical differentiation between acute arterial embolism and acute arterial thrombosis of the lower extremities. J Med Assoc Thai 2009;92(7):891-7.
• Rost C, Daniel WG, Schmid M. Giant left atrial thrombus in moderate mitral stenosis. Eur J Echocadiogr 2009;10(2):358-9.
• Kaymaz C, Ozdemir N, Kirma C, Sişmanoglu M, Daglar B, Ozkan M. Location, size and morphological characteristics of left atrial thrombi as assessed by echocardiography in patients with rheumatic mitral valve disease. Eur J Echocardiogr 2001;2(4):270-6.
• Carroll JD. [Cardiology], Kardiyoloji Türkçe çevirisi. Mitral darlığı. Editör: Candan İ, Oral D. Antıp AŞ. Tıp Kitapları Ve Bilimsel Yayınlar. 2002.p. 832-57.
• Brewster DC, Chin AK, Fogarty TJ. Arterial thromboembolism. In: Rutherford RB; Vascular Surgery.Philadelphia W.B. Saunders Company, Third Edition 1989;8(3):546-64.
• Haimovici H. Cardiogenic embolism of the upper extremity. J Cardiovasc Surg (Torino) 1982;23(3):209-13.
• Walle BF, Howard J, Fess S. Pathology of mitral valve stenozis and pure mitral regurgitation. Part II. Clin Cardiol 1994;17(7):395-402.
• Chiang CW, Lo SK, Ko YS, Cheng NJ, Pin PJ,Chang CH. Predictors of systemic embolism in patients with mitral stenosis. A prospective study. Ann Intern Med A 1998;128(11):885-9.
• Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, et al. Guidelines on the menagement of valvular heart disease: The Task Force on the Menagement Valvular Heart Disease of the European Society of Cardiology. Eur Heart J 2007;28(2):230-68.