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THE JOURNAL OF CARDIOVASCULAR SURGERY
A Journal on Cardiac, Vascular and Thoracic Surgery
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632
CASE REPORTS CARDIAC PAPERS
The Journal of Cardiovascular Surgery 1998 October;39(5):649-50
Mural left atrial thrombus: a hidden danger accompanying cardiac surgery
Leslie D., Hall T. S., Goldstein S.*, Shindler D.**
From the Department of Surgery, * Department of Anesthesia, ** Clinical Medicine Robert Wood Johnson Medical School University of Medicine & Dentistry of New Jersey, USA
Objective. To emphasize a potentially lethal condition that is virtually impossible to diagnose preoperatively.
Design. Case report with review of the literature.
Setting. University Hospital.
Participant. The patient requiring urgent surgery for heart failure related to severe aortic stenosis and mild mitral stenosis with poor ventricular function. The patient was elderly and suffered from atrial fibrillation.
Interventions. Preoperative transesophageal echocardiography followed by mitral valve repair and aortic valve replacement.
Measurements. Clinical outcome and pathological results.
Results. Although preoperative TEE demonstrated no left atrial appendage abnormality. After cardiac manipulation prior to the institution of cardiopulmonary bypass a large left atrial mural thrombus was mobilized from the atrial wall and was free floating in the left atrium.
Conclusions. For high risk patients TEE should be applied intraoperatively to avoid undiagnosed left atrial clot dislodgement.