Erdoğan YAŞAR, Ferhat EYYÜPKOCA, Yılmaz Ömür OTLU, Şiho HİDAYET

NONVALVÜLER ATRİYAL FİBRİLASYON İLE İLİŞKİLİ SAĞ ATRİYAL APENDİKSTE TROMBÜS: ASLA SAĞ ATRİYAL APENDİKSİ UNUTMAYIN

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 kliniğimizebaşvurdu. Transözefagial ekokardiyografi de (TÖE), sağ atriyal apendikste 1.5x4.0 cm boyutundatrombüs 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 olgusunumunda; NVAF'a tedavi yaklaşımını belirlemeden önce transözofageal ekokardiyografi ileSAA'in yanı sıra sağ atriyal apendiks muayenesinin de dikkatle yapılması gerektiğini vurgulamayı amaçladık.

A Thrombus in Right Atrial Appendage in Association with Nonvalvular Atrial Fibrillation: Never Forget Right Atrial Appendage

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 worseningcomplaint of dyspnea. TEE revealed spontaneous echo contrast (SEC) in both atria with thepresence of thrombus 1.5x4.0 cm in size from right atrial appendage (RAA). No thrombusdetected 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.

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1. Nugert GR, Lucus R, Judy M, et al. Thromboembolic complications in ventriculoatrial shunts. J Neurosurg 1966; 24:34-36.
2. London AR, Runge PJ, Balsin RF, et al. Large right atrial thrombi surrounding permanent transvenous pacemaker. Circulation 1969; 39:661-664.
3. de Divitiis M, Omran H, Rabahieh R, et al. Right atrial appendage thrombosis in atrial fibrillation: its frequency and its clinical predictors. Am J Cardiol. 1999;84:1023-1028
4. Rozenberg V, Boccara F, Benhalima B, et al. Comparison of echocardiographic markers of embolism in atrial flutter and fibrillation:frequency of protruding atherosclerotic plaques in the thoracic aorta. Echocardiography. 2000;17:555-562.
5. Subramaniam B, Riley MF, Panzica PJ, et al. Transesophageal echocardiographic assessment of right atrial appendage anatomy and function: comparison with the left atrial appendage and implications for local thrombus formation. J Am Soc Echocardiogr. 2006;19:429-433.
6. Willoughby SR, Roberts-Thomson RL, et al. Atrial platelet reactivity in patients with atrial fibrillation. Heart Rhythm.; 2010;7(9): 1178-1183.
7. Bilge M, Eryonucu B, Güler N, et al. Right Atrial Appendage Function in Patients with Chronic Nonvalvular Atrial Fibrillation. Jnp Heart J. 2000 Jul;41(4):451-462.
8. Manning WJ, Silverman DI, Keighley CS, et al. Transesophageal echocardiographically facilitated early cardioversion from atrial fibrillation using short-term anticoagulation: final results of a prospective 4.5-year study. J Am Coll Cardiol. 1995;25:1354-1361.
9. Klein AL, Grimm RA, Murray RD, et al. Use of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation. N Engl J Med. 2001;344:1411-1420.
10. Sahin T, Ural D, Kilic T,et al.Right atrial appendage function in different etiologies of permanent atrial fibrillation: a transesophageal echocardiography and tissue Doppler imaging study. Echocardiography; 2010; 27(4):384-393.
11. Pesavento R, Piovella C, Prandoni P. Heart disease in patients with pulmonary. embolism. Curr Opin Pulm Med.; 2010; 16(5): 415-418.
12. Ogren M, Berggvist D, Eriksson H, et al. Prevalence and risk of pulmonary embolism in patients with intracardiac thrombosis: a population-based study of 23796 consecutive autopsies. Eur Heart J. 2005; 26(11): 1108-1114.
13. Kaplan M, Demirtas M, Cimen S,et al. Cardiac hydatid cysts with intracavitary expansion. Ann Thorac Surg. 2001;71:1587-1590.
14. Singh AV, Walsh JT, Birdi IS. Right atrial thrombus masquerading as intracardiac cyst: A case report. Asian Cardiovasc Thorac Ann. 2008 Aug;16(4):e35-36.