Work

Left Atrial Thrombus in Rheumatic Mitral Stenosis

Year: 2025

Type: article

Abstract: BACKGROUND: Atrial fibrillation or flutter in rheumatic mitral stenosis (MS) increases left atrial appendage (LAA) thrombus risk despite therapeutic anticoagulation. CASE SUMMARY: A 72-year-old woman on warfarin with moderate MS and atrial flutter presented with dyspnea. Transesophageal echocardiogram (TEE) showed a large LAA thrombus despite an international normalized ratio >2.5. Cardioversion was deferred, and the international normalized ratio target was raised to a range of 2.5 to 3.5. TAKE-HOME MESSAGES: While cardioversion can be considered in patients with uninterrupted anticoagulation without TEE, those with rheumatic MS are at high risk of LAA and LA thrombus and should undergo TEE before the procedure. Further research is needed to explore whether LAA thrombus warrants surgical intervention for rheumatic MS.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.104884

Authors: Muhammad Salman Sabri, Carly Weber, Yanis Belkadi, Donald Haas, Yasotha Rajeswaran

Institution: Lehigh Valley Hospital

Language: English

Topic: Atrial Fibrillation Management and Outcomes

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850