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Oral antikoagülasyon ile tedavi edilen serbest yüzen sol atriyal top trombüsü

Yıl 2023, Cilt: 16 Sayı: 3, 522 - 527, 01.07.2023
https://doi.org/10.31362/patd.1259424

Öz

Dış merkeze karın ağrısı nedeniyle başvurup böbrek ve dalakta enfarktüs saptanması nedeniyle ileri inceleme için hastanemize yönlendirilen, mekanik protez mitral kapak nedeniyle varfarin almakta olan ancak yakın zamanda kalp dışı cerrahi nedeniyle varfarin kesilip enoksaparin ile tedavi öyküsü olan 56 yaşındaki bir erkek hastaya tarafımızca yapılan transözofageal ekokardiyografide (TEE) serbest yüzen sol atriyal top trombüsü saptandı. Kalp cerrahları tarafından cerrahi müdahale açısından yüksek riskli olarak değerlendirilen hasta, varfarin rejimi ile tedavi edildi ve tedavinin 14. gününde bilgisayarlı tomografi (BT) taramasında trombüsün kaybolduğu görüldü. Bu olgu sunumuna göre, serbest yüzen sol atriyal top trombüsü olan hastalar cerrahi girişim açısından yüksek risk altındaysa, cerrahiye alternatif olarak varfarin tedavisi düşünülebilir.

Kaynakça

  • 1. Yalta K, Yilmaz A, Turgut OO, et al. Acute heart failure and near-syncope associated with giant left atrial ball thrombus occluding left ventricular inflow tract. Eur J Echocardiogr 2008;9:86-87. https://doi.org/10.1016/j.euje.2007.02.003
  • 2. Hisatomi K, Hashizume K, Tanigawa K, et al. Free-floating left atrial ball thrombus after mitral valve replacement with patent coronary artery bypass grafts: successful removal by a right minithoracotomy approach without aortic cross-clamp. Gen Thorac Cardiovasc Surg 2016;64:333-336. https://doi.org/10.1007/s11748-014-0462-2
  • 3. Kaneda T, Iemura J, Michihata I, et al. Two cases of a free-floating ball thrombus in the left atrium. Circ J 2002;66:869-871. https://doi.org/10.1253/circj.66.869
  • 4. Nurra V, Calisi P, Astengo D, et al. Free-floating left atrial thrombus: echocardiographic demonstration and treatment with oral anticoagulation. Am J Noninvas Cardiol 1994;8:51-52. https://doi.org/10.1159/000470158
  • 5. Wolff G, Kelm M, Westenfeld R, Horn P. Low-dose thrombolysis for the management of left atrial thrombus formation during percutaneous mitral valve repair. JACC: Cardiovasc Interv 2019;12:9-10. https://doi.org/10.1016/j.jcin.2018.10.012
  • 6. Safani M, Appleby S, Chiu R, et al. Application of anti-Xa assay in monitoring unfractionated heparin therapy in contemporary antithrombotic management. Expert Review of Hematology 2023;16:1-8. https://doi.org/10.1080/17474086.2023.2169126

A free floating left atrial ball thrombus treatment with oral anticoagulation

Yıl 2023, Cilt: 16 Sayı: 3, 522 - 527, 01.07.2023
https://doi.org/10.31362/patd.1259424

Öz

Transesophageal echocardiography (TEE) revealed a free-floating left atrial ball thrombus in a 56-year-old male patient who was taking warfarin for mechanical prosthetic mitral valve and had recently short-term warfarin interruption for noncardiac surgery and bridging with enoxaparin was admitted to an external center for left abdominal pain and after the detection of spleen and renal infarct, the patient was referred to us for further examination. The patient, who was considered to be at high risk for surgical intervention by the cardiac surgeons, was treated with a warfarin regimen and on the 14th day of the treatment, computed tomography (CT) scan showed that the thrombus disappeared. According to this case report, if patients who have a free-floating left atrial ball thrombus are at high risk for surgical intervention, warfarin therapy can be considered as an alternative to surgery

Kaynakça

  • 1. Yalta K, Yilmaz A, Turgut OO, et al. Acute heart failure and near-syncope associated with giant left atrial ball thrombus occluding left ventricular inflow tract. Eur J Echocardiogr 2008;9:86-87. https://doi.org/10.1016/j.euje.2007.02.003
  • 2. Hisatomi K, Hashizume K, Tanigawa K, et al. Free-floating left atrial ball thrombus after mitral valve replacement with patent coronary artery bypass grafts: successful removal by a right minithoracotomy approach without aortic cross-clamp. Gen Thorac Cardiovasc Surg 2016;64:333-336. https://doi.org/10.1007/s11748-014-0462-2
  • 3. Kaneda T, Iemura J, Michihata I, et al. Two cases of a free-floating ball thrombus in the left atrium. Circ J 2002;66:869-871. https://doi.org/10.1253/circj.66.869
  • 4. Nurra V, Calisi P, Astengo D, et al. Free-floating left atrial thrombus: echocardiographic demonstration and treatment with oral anticoagulation. Am J Noninvas Cardiol 1994;8:51-52. https://doi.org/10.1159/000470158
  • 5. Wolff G, Kelm M, Westenfeld R, Horn P. Low-dose thrombolysis for the management of left atrial thrombus formation during percutaneous mitral valve repair. JACC: Cardiovasc Interv 2019;12:9-10. https://doi.org/10.1016/j.jcin.2018.10.012
  • 6. Safani M, Appleby S, Chiu R, et al. Application of anti-Xa assay in monitoring unfractionated heparin therapy in contemporary antithrombotic management. Expert Review of Hematology 2023;16:1-8. https://doi.org/10.1080/17474086.2023.2169126
Toplam 6 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Kalp ve Damar Cerrahisi
Bölüm Olgu Sunumu
Yazarlar

Harun Akarsu 0000-0001-9178-9972

Asuman Kaftan 0000-0002-5073-7348

Yiğit Davutoğlu 0000-0001-7485-156X

Gürsel Şen 0000-0002-1211-4772

Erken Görünüm Tarihi 23 Haziran 2023
Yayımlanma Tarihi 1 Temmuz 2023
Gönderilme Tarihi 22 Mart 2023
Kabul Tarihi 19 Haziran 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 16 Sayı: 3

Kaynak Göster

AMA Akarsu H, Kaftan A, Davutoğlu Y, Şen G. A free floating left atrial ball thrombus treatment with oral anticoagulation. Pam Tıp Derg. Temmuz 2023;16(3):522-527. doi:10.31362/patd.1259424
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