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Fragile left atrial thrombus successfully treated with anticoagulants
  1. C Ogata,
  2. S Nakatani,
  3. M Yamagishi

  1. myamagi{at}

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A 64 year old woman who had had a history of hypertension was admitted to our hospital because of congestive heart failure associated with atrial fibrillation. The patient was well until two weeks before admission when she noticed exertional dyspnoea. There was no evidence for systemic embolisation. On admission, atrial fibrillation still remained and echocardiography showed mild hypertrophy of the left ventricle probably caused by hypertension. In the left atrium there was an abnormal mass suggesting the presence of a thrombus. Using the transoesophageal approach, the mobile “cauliflower”-like mass image was found to be attached to the anterior left atrial wall (below left). Based on echocardiographic findings such as the size and mobility of the mass, surgical removal was considered as one of the therapeutic options. However, the patient refused to have surgery, and so treatment with heparin (15000 U/day) and coumadin (3 mg/day) was initiated which dramatically reduced the size of the mass (below centre). By the 16th day of treatment, the mass had completely disappeared without any episode of systemic embolisation (below right). We suggest that anticoagulation treatment can resolve a relatively large and mobile left atrial thrombus without serious complications, although careful observation by echocardiography should be done for possible occurrence of systemic embolisation.

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