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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 1998 October;39(5):649-50

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


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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.

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