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Case Studies | Cardiology Science | India | Volume 11 Issue 11, November 2022
Wrong at Right-A Rare Presentation of Right a Trial Thrombus
Nithin Bharadwaj | Dr. Chandra Shekara Reddy | Dr. Arun Sriniivas | Dr. Siddarth Kumar Chawath | Dr. Lakshminarayan Achar
Abstract: Background: Rheumatic Heart Disease is one of the common Valvular Heart Disease. Associated Atrial Fibrillation may result in Cardio Embolic Stroke and related complications. Case Presentation: Sixty-year old male admitted with palpitation and breathlessness since 2 weeks and aggravated since 3 days. He had past history of CVA and Seizure Disorder. He underwent PTMC for RHD-Severe MS (2009) and Craniotomy for SDH drainage (2009). Currently had Severe MS, AF with FVR, Large LA Clot, Severe TR, Severe LV Systolic Dysfunction, Cardiogenic Shock and Respiratory failure. Managed with Anti Arrhythmics, Inotropes and Mechanical Ventilation supports. His Coronary Angiogram was Normal. After CTVS consultation with high-risk consent under GA and CPB support, underwent successful removal of Bi Atrial Clots (RA Clot was an incidental finding) and MVR with 27 mm TTK Chitra Heart Valve. Clinical course was complicated by AKI & deranged LFT (symptomatically treated) Bilateral Pleural Effusion (drained) and Rt. Vocal Card Palsy (Tracheostomy done). Gradients across MV improved at discharge. Discussion: RA thrombus is rare. Clinical presentation varies from Asymptomatic to PE to SCD. Echocardiography, CT and CMR are useful noninvasive diagnostic tools. Treated with Anticoagulants, Thrombolysis or Surgical thrombectomy. Multidisciplinary approach is the cornerstone for successful diagnosis, treatment and follow up. Conclusion: Early diagnosis and management of Intra Cardiac Thrombi are key to prevent systemic complications. Systemic Anticoagulation should be considered carefully on case to case basis. Mortality in Right Heart Thrombi remains high regardless of the cause or chosen treatment.
Keywords: Intra Cardiac Thrombi, Pulmonary Embolism, Severe Mitral Stenosis, Thrombo Embolism, Percutaneous Transvenous Mitral Commissurotomy, Systemic Anticoagulation
Edition: Volume 11 Issue 11, November 2022,
Pages: 1272 - 1277