Document Type
Article
Publication Date
9-3-2025
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.
Recommended Citation
Sabri, Muhammad Salman; Weber, Carly; Belkadi, Yanis; Haas, Donald C.; and Rajeswaran, Yasotha, "Left Atrial Thrombus in Rheumatic Mitral Stenosis: A Case of Therapeutic International Normalized Ratio Failure" (2025). Division of Internal Medicine Faculty Papers & Presentations. Paper 69.
https://jdc.jefferson.edu/internalfp/69
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Transesophageal Echocardiogram Demonstrates Swirling of Contrast in the Left Atrium Concerning Stasis of Blood Flow in the Left Atrium and Stenotic Mitral Valve.mp4 (1789 kB)
Transesophageal Echocardiogram Demonstrates Thrombus in the Left Atrial Appendage.mp4 (1583 kB)
Transesophageal Echocardiogram Showing Smoke in the Left Atrium and Stenotic Calcified Mitral Valve With Mitral Annular Calcification.mp4 (1996 kB)
PubMed ID
40912841
Language
English
Comments
This article is the author's final published version in JACC: Case Reports, Volume 30, Issue 26, September 2025, Article number 104884.
The published version is available at https://www.doi.org/10.1016/j.jaccas.2025. Copyright © The Author(s).