Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2014;67:1054 - Vol. 67 Num.12 DOI: 10.1016/j.rec.2014.02.018

Dislodgement and Embolization of a Left Atrial Appendage Thrombus

Ignacio Hernández González a, Miguel Ángel Navas Lobato a,, Jerónimo Farré Muncharaz a

a Servicio de Cardiología, Hospital Universitario Fundación Jiménez Díaz, IDC Salud, Universidad Autónoma de Madrid, Madrid, Spain

Article

An 80-year-old man was admitted to our center because of recurrent ischemic strokes. Notably, the patient had recently been diagnosed with adenocarcinoma of the lung and was waiting to start radiation therapy. In addition, he was receiving chronic anticoagulation therapy with a coumarin derivative for permanent atrial fibrillation and maintained adequate international normalized ratio (INR) control.

We performed a transesophageal study to evaluate the sources of embolism. The image, a 2-chamber view of the mid-esophagus and its orthogonal projection, obtained simultaneously by a 3-dimensional probe (Figure, Video 1 of the supplementary material), showed a thrombus (10 mm × 8 mm) attached to the atrial appendage wall. During the procedure, we observed the precise moment when the thrombus became detached from its anchorage on the atrial appendage wall and its mobilization (Figure, Video 2 of the supplementary material). Following the disappearance of the thrombus, the pectinate muscles were identified only at the level of the tip of the atrial appendage pouch (Figure, Video 3 of the supplementary material). During the study, there were no changes in rhythm, which remained in atrial fibrillation. The patient had a splenic infarction, confirmed by computed tomography.

Figure.

Thrombus formation in the left atrial appendage can occur in individuals with lung cancer, despite adequate anticoagulation with vitamin K antagonists. The findings in our patient led to a change in the anticoagulant therapy, and anticoagulation with low-molecular-weight heparin was initiated.

SUPPLEMENTARY MATERIAL

Video 1

Video 2

Video 3

Corresponding author: manavaslol@gmail.com

1885-5857/© 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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