Echocardiography for assessment of left atrial stasis and thrombosis – three cases report

Ionela Tanasa, Raluca Arhirii, Radu Popa, Antoniu Petriş

Abstract


We report three cases of chronic atrial fibrillation without anticoagulation admitted for acute lower limb ischemia in which embolic source was left atrial appendage (LAA) thrombus revealed only by transesophageal echocardiography (TEE). Transthoracic echography (TTE) revealed left atrial dilatation (LA) with no contrast or intracavitary mass. TEE revealed LA with spontaneous echographic contrast, low ostial emptying velocities and congenital morphology of LAA with older and organized thrombus or with echolucent centre (” beard-beark sign of recent and growing thrombus”) and thoracic aorta atheroma plaques. They were discharged on acenocumarol/ novel oral anticoagulant therapy. Two-dimensional echocardiography should be recommended in all patients with periprocedural acute peripheral embolism and TEE only in selected cases. Very high incidence of acute embolic ischemia is probably due to lack of preoperative anticoagulation more than to nontherapeutical anticoagulation (international normalized ratio INR<2).

Keywords


atrial fibrillation, left atrial, thrombosis, acute limb ischemia

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References


Maehama T, Okura H, Imai K, et al. Usefulness of CHADS2 score to predict C-reactive protein, left atrial blood stasis, and prognosis in patients with non-rheumatic atrial fibrillation. Am J Cardiol 2010; 106(4):535-538.

Romero J, Cao JJ, Garcia MJ, Taub CC. Cardiac imaging for assessment of left atrial appendage stasis and thrombosis. Nat Rev Cardiol 2014; 11(8):470-480.

Singla V, Singh Y, Ravindranath SK, Manjunath CN. ‘Bird-beak sign’ of left atrial thrombus: a guide to management. BMJ Case Rep, 2013, doi:10.1136/bcr-2013-010459.

Sawit ST, Garcia-Alvarez A, Suri B, et al. Usefulness of cardiac computed tomographic delayed contrast enhancement of the left atrial appendage before pulmonary vein ablation. Am J Cardiol 2012; 109(5):677- 684.

Lohrmann GM, Peters F, van Riet S, Essop MR. Double Trouble – A Case Report of Mobile Right Atrial Thrombus in the Setting of Acute Pulmonary Thromboembolism. Heart, Lung Circulation 2014; 23:214– 216.

Dorenkamp M, Sohns C, Vollmann, D et al. Detection of left atrial thrombus during routine diagnostic work-up prior to pulmonary vein isolation for atrial fibrillation: role of transesophageal echocardiography and multidetector computed tomography. Int J Cardiol 2013; 163(1):26- 33.

Tahara A, Tahara N, Honda A, Imaizumi. Mobile left atrial round mass free floating in mitral regurgitation flow mimicking a whale spray. BMJ Case Rep 2014; doi: 10.1136/bcr-2013-202725.

Black IW. Spontaneous echo contrast: where there's smoke there's fire. Echocardiography 2000; 17(4):373-382.

Shirani J, Alaeddini J. Structural remodeling of the left atrial appendage in patients with chronic non-valvular atrial fibrillation: Implications for thrombus formation, systemic embolism, and assessment by transesophageal echocardiography. Cardiovasc Pathol 2000; 9(2):95-101.

Zabalgoitia M, Halperin JL, Pearce LA, Blackshear JL, Asinger RW, Hart RG. Transesophageal echocardiographic correlates of clinical risk of thromboembolism in nonvalvular atrial fibrillation. Stroke Prevention in Atrial Fibrillation III Investigators. J Am CollCardiol 1998; 31(7):1622-1626.

Cohen A, Chauvel C, Abergel E, Albo C, Benhalima B, Valty J. Value of transesophageal echocardiography in the cardiovascular assessment of an ischemic cerebral accident of suspected embolic origin. Ann Radiol 1994; 37(1-2):29-40.

Yamamoto M, Seo Y, Kawamatsu N, et al. Complex left atrial appendage morphology and left atrial appendage thrombus formation in patients with atrial fibrillation. Circ Cardiovasc Imaging 2014; 7(2):337-343.

Rathi VK, Reddy ST, Anreddy S, et al. Contrast-enhanced CMR is equally effective as TEE in the evaluation of left atrial appendage thrombus in patients with atrial fibrillation undergoing pulmonary vein isolation procedure. Heart Rhythm 2013; 10(7):1021-1027.

Luca C, Ciubotaru A, Leferman C, Anghel R, Deju E, Tinică G. Leriche Syndrome in a post-CABG patient. Arch Clin Cases 2015; 2(1):12-17.




DOI: http://dx.doi.org/10.22551/2015.06.0202.10038

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