An Unusual Case of Left Atrial Mural Thrombus following Aortic Valve Replacement

Abstract EN

The left atrial thrombus is a well-known complication of atrial fibrillation and rheumatic mitral valve disease and carries a high risk for systemic thromboembolism.

They are generally dissolved after a certain period of optimal anticoagulation.

A large thrombus, on the other hand, may persist even with adequate anticoagulation.

The surgical removal of a thrombus theoretically poses some risk of systemic embolization, making its management a clinical dilemma.

Furthermore, a refractory thrombus is uncommon.

Thus, an evidence-based guideline in selecting the optimal therapy is needed.

We report a case of a 74-year-old male with atrial fibrillation and a history of unprovoked pulmonary embolism who was incidentally found to have a massive left atrial thrombus shortly after discontinuing warfarin about 4 months following bioprosthetic aortic valve replacement.

The thrombus was refractory to anticoagulation posing a clinical management dilemma.

This case is interesting in terms of presentation and the approach to diagnosis and treatment.