Left Atrial Thrombus Formation in a Patient With Severe Non-rheumatic Mitral Stenosis After Mitral Valve Repair Receiving Dual Antiplatelet Therapy: A Clinical Challenge.

A 60-YEAR-OLD, 88-kg, 165-cm woman presented to a community hospital with heart failure 5 years after mitral valve repair for mitral regurgitation. The patient previously suffered an ischemic stroke and was currently treated with dual antiplatelet therapy. Transesophageal echocardiography revealed severe mitral stenosis with a mean transmitral gradient of 10 mmHg and thickening of the posterior left atrial wall. The patient was then transferred to the authors’ institution for mitral valve replacement. During surgery, transesophageal echocardiography revealed moderate-to-severe non-rheumatic mitral stenosis with a mean transmitral pressure gradient of 7 mmHg (Fig 1). There also was an immobile density extending from the mitral valve annuloplasty ring to the posterior left atrial wall (Fig. 2 and 3; Video 1). What is the diagnosis? Fig 2Two-dimensional modified long-axis transesophageal echocardiography image showing a thrombus extending from the mitral annuloplasty ring to the posterior left atrial wall. AV, aortic valve; LA, left atrium; LV, left ventricle. View Large Image Figure Viewer Download Hi-res image Fig 3Photograph of the left atrial mural thrombus after resection. View Large Image Figure Viewer Download Hi-res image