NONVALVÜLER ATRİYAL FİBRİLASYON İLE İLİŞKİLİ SAĞ ATRİYAL APENDİKSTE TROMBÜS: ASLA SAĞ ATRİYAL APENDİKSİ UNUTMAYIN! A Thrombus in Right Atrial Appendage in Association with Nonvalvular Atrial Fibrillation: Never Forget Right Atrial Appendage!

Öz

Nonvalvüler atriyal fibrilasyon (NVAF) erişkinlerde en sık görülen sürekli aritmidir ve kusurlu

atriyal kontraksiyonların sonucu atriyal trombüs oluşumuna neden olabilir. Sol-taraflı kardiyak

trombüsler genellikle miyokard enfarktüsü, dilate kardiyomiyopati veya mitral kapak hastalığı ile

ilişkilidir. Öte yandan sağ taraflı kardiyak trombüsler sekonder nedenlerden oluşabilir, daha az

görülür ve literatürde birkaç sağ atriyal trombüs vaka raporu bildirilmiştir (1,2).

Sürekli AF hikayesi olan 72 yaşındaki kadın hasta, nefes darlığı yakınması nedeniyle kliniğimize

başvurdu. Transözefagial ekokardiyografi de (TÖE), sağ atriyal apendikste 1.5x4.0 cm boyutunda

trombüs ile birlikte her iki atriumda da spontan eko kontrast (SEK) bulgusu izlendi. Sol atriyum

(SA) ve sol atriyal appendiks (SAA) taramasında herhangi bir trombüse rastlanmadı. Bu olgu

sunumunda; NVAF’a tedavi yaklaşımını belirlemeden önce transözofageal ekokardiyografi ile

SAA’in yanı sıra sağ atriyal apendiks muayenesinin de dikkatle yapılması gerektiğini vurgulamayı

amaçladık.

Anahtar Sözcu¨kler: Atrial fibrilasyon; Sağ atrium; Trombüs

ABSTRACT

Nonvalvular atrial fibrillation (NVAF) is the most common sustained arrhythmia in adults and

result of defective atrial contractions may cause atrial thrombi formation. Left-sided cardiac

thrombi are often associated with myocardial infarction, dilated cardiomyopathy or mitral valve

disease. On the other hand, right-sided cardiac thrombi may consist of secondary causes, less

often seen and a few case reports of right atrial (RA) thrombus have been described in the

literatüre(1,2).

A 72 year-old woman with permanent AF history was admitted to our clinic because of worsening

complaint of dyspnea. TEE revealed spontaneous echo contrast (SEC) in both atria with the

presence of thrombus 1.5x4.0 cm in size from right atrial appendage (RAA). No thrombus

detected during screening of left atrium (LA) and left atrial appandage (LAA). In this case report;

we aimed to emphasise that transesophageal echocardiography (TEE) examination of the RAA

should be done carefully before deciding the treatment modality in nonvalvular AF as well as

LAA.

Keywords: Atrial fibrillation, Right atrium; Thrombus

Anahtar Kelimeler

• NONVALVÜLER ATRİYAL FİBRİLASYON İLE İLİŞKİLİ SAĞ ATRİYAL APENDİKSTE TROMBÜS: ASLA SAĞ ATRİYAL APENDİKSİ UNUTMAYIN! A Thrombus in Right Atrial Appendage in Association with Nonvalvular Atrial Fibrillation: Never Forget Right Atrial Appendage!

Kaynakça

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