Abstract Number: PB0107
Meeting: ISTH 2021 Congress
Background: Myocarditis,pericarditis,acute infections and atrial surgery are risk factors for the development of atrial flutter.
Aims: Here,a 15-year-old male patient who underwent cardiac surgery at newborn period and developed atrial flutter and intraatrial thrombus in the follow-up is presented together with the diagnostic and therapeutic approaches.
Methods: A fifteen-year-old male patient was admitted to the emergency room due to palpitations.It was learned that he had undergone a total correction operation with the diagnosis of “Total pulmonary venous return anomaly and atrial septal defect”at newborn period, and received metoprolol treatment for ventricular extrasystoles.All blood tests were found to be normal.Physical examination revealed bradycardia and sinus node dysfunction.During the treadmill exercise test,atrial flutter developed in the patient(Figure 1).Oral antithrombotic therapy was started because of the high risk of thromboembolism.In transesophageal ECHO(TEE),thrombus was detected at the apex of the right atrium(Figure 2)and LMWH treatment was started.Hyperhomocysteinemia and heterozygous FV Leiden mutations were detected in the thrombosis panel
Results: It was observed that the thrombus had shrunk 3 weeks after anticoagulant treatment.For medical cardioversion,amiodarone was started.Electrical cardioversion was applied to the patient who did not respond to medical cardioversion.It was observed that the atrial flutter rhythm was improved.In the TEE performed for control,the thrombus in the atrium was in an organized appearance.Due to the development of sinus node dysfunction secondary to the operation,the patient was implanted with a pacemaker.No thrombus was detected in ECHO at the last examination,and the patient continues to take oral anticoagulants,digoxin,beloc,cordarone and folbiol.
Conclusions: There may be a tendency to thrombosis in congenital/acquired heart diseases,surgical conditions or rhythm disturbances.Atrial flutter is an important risk factor for the development of atrial thrombosis.The diameter of the clot and its motility play a role in treatment.Systemic anticoagulant therapy is recommended in high risk situations.Thrombectomy or thrombolytic therapy is controversial and should be evaluated individually according to the patient.
To cite this abstract in AMA style:Karaman S, Gokceer Karabulut D, Unuvar A, Sahin S, Nisli K, Tugcu D, Tanyildiz G, Tuna R, Bilici M, Karakaş Z. Atrial Flutter and Intracardiac Thrombus After Cardiac Surgery [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/atrial-flutter-and-intracardiac-thrombus-after-cardiac-surgery/. Accessed September 24, 2021.
« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/atrial-flutter-and-intracardiac-thrombus-after-cardiac-surgery/