Harun AKARSU, Asuman KAFTAN, Yiğit DAVUTOĞLU, Gürsel ŞEN

Oral antikoagülasyon ile tedavi edilen serbest yüzen sol atriyal top trombüsü

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.

Anahtar Kelimeler:

Trombüs, Antikoagülasyon, Ekokardiyografi

A free floating left atrial ball thrombus treatment with oral anticoagulation

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

Keywords:

Thrombus, Anticoagulation, Echocardiography,

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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