Left atrial thrombosis after heart transplantation (original) (raw)
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Massive Thrombosis of the Transplanted Heart in the Early Postoperative Period
Journal of cardiac surgery, 2016
We experienced a case with the left atrium almost completely filled with a thrombus after orthotopic heart transplantation while the patient was supported on extracorporeal membrane oxygenation for primary graft failure. The patient had recurrent thrombosis even after successful surgical thrombectomy and appropriate anticoagulation. The cardiac thrombosis resolved only after starting plasmapheresis. doi: 10.1111/jocs.12674 (J Card Surg 2016;31:117-119).
Right atrial thrombus derived from inferior vena cava after liver transplantation
International Journal of Case Reports and Images, 2012
Introduction: Rightsided cardiac thrombi may develop due to secondary causes. Their incidence is very low and only a few case reports of right atrial (RA) thrombi exit in literature. Case Report: We report the case of a 56yearold patient with orthotopic liver transplantation (OLT) about six months back, who was admitted to our clinic with symptoms of worsening chest pain and shortness of breath. Two and three dimensional transthoracic echocardiography (3DTTE) and transesophageal echocardiogram (TEE) showed a mobile right atrial thrombus 3.9×1.8 cm in size, traversing the right atrial cavity during the whole cardiac cycle. After one week of therapeutic anticoagulation, the thrombus began to shrink and after three weeks echocardiography confirmed no evidence of residual thrombus. Conclusion: In contrast to previously reported cases of massive RA thrombosis developing intraoperatively during OLT, in our case a RA thrombus developed six months after OLT. The right atrial thrombus was derived from inferior vena cava.
Diagnosis of a huge right atrial thrombus during coronary artery bypass graft surgery
The American journal of case reports, 2013
Male, 73 FINAL DIAGNOSIS: Coronary artery thrombosis Symptoms: Angina pectoris • short of breath - Clinical Procedure: CABG Specialty: Cardiology. Management of emergency care. Intra-operative formation of a thrombus in the right heart is rare and might be unrecognized. However, it can be associated with severe consequences, including pulmonary embolism and death. We report the case of a 73-year-old man who presented to the cardiologist with angina pectoris and rare shortness of breath. Coronary artery bypass grafting (CABG) was performed due to multi-vessel disease. Because of hemodynamic insufficiency, an intra-operative transesophageal echocardiogram (TEE) was performed and a huge free-floating thrombus was detected. Multiple thrombi were removed from the right heart and pulmonary arteries. The patient died after cardiopulmonary bypass support and 12 hours of intensive care. In this case report, we emphasize the importance of the TEE during the preoperational period and during CA...
Surgery-Related Complications in Cardiac Transplantation Patients
Transplantation Proceedings, 2008
Objective. The surgical techniques was first described by Lower and Shumway for cardiac transplantation have not changed for many years; they are still being commonly used worldwide despite recently presented alternatives. We sought to evaluate the surgical complications among our cardiac transplantation patients in whom we performed the standard technique. Patients and methods. The standard biatrial anastomosis technique was used in 13 patients who have a mean follow-up of 18.6 (1 to 38) months. During the follow-up, echocardiographic assesment was performed to evaluate left and right atrial diameters, tricuspid and mitral valve regurgitation, interatrial septum, and suture lines. Elecotrocardiograms were evaluated for arryhthmia and pacemaker requirements in the midterm. Results. The mean left and right atrial diameters were measured as 40.5 (32 to 57) ϫ 66.6 (48 to 78) and 37.9 (32 to 43) ϫ 56.3 (48 to 69) mm, respectively. The jet area was calculated at less than 5 cm 2 for mitral and tricuspid valve regurgitation, which can be defined as "mild" regurgitation. There was no increase in the degree of regurgitation of both atrioventricular valves during the follow-up period. In one patient, a thrombus was detected in the suture line; there was a nonsignificant left to right shunt in another patient. A temporary pacemaker was indicated in two patients. Atrial fibrillation was detected in three patients, who responded to medical therapy. During the follow-up atrial fibrillation developed in one patient. Conclusion. The cardiac transplantation operation using the standard technique may result in atrial dysfuntion due to deformation of atrial integrity and geometry. However, when we evaluated our results, we concluded that the standard surgical technique was a safe, simple, effective, and feasible method.
Central venous catheter-related right atrial thrombus in two kidney transplantation recipients
NDT Plus, 2010
Right atrial thrombus formation is a known mechanical complication of central venous catheter insertion, with an incidence of between 1.9% and 42%. There is an increased risk of thromboembolism following renal transplantation. However, a right atrial thrombosis is rarely reported in renal transplant recipients. Here, we report two cases of renal transplant recipients in whom a right atrial thrombus developed after kidney transplantation. One of them required surgery, whereas the other patient recovered after being given an anticoagulant therapy with warfarin.
Atrial fibrillation after orthotopic heart transplantatation: Pathophysiology and clinical impact
IJC Heart & Vasculature, 2021
Background: Atrial fibrillation (AF) is a well-established post-cardiac surgery complication. Orthotopic heart transplantation (OHT) represents a peculiar condition where surgical thoracic veins isolation and autonomic denervation occur. This study aims at investigating AF incidence in OHT in order to define its risk factors and to evaluate its prognostic impact. Methods: 278 patients affected by OHT were recruited in our Cardiac Surgery Unit and retrospectively analyzed, using clinical, surgical and instrumental data. Results: The patients cohort showed 45 post-operative (16.5%) and 20 late AF cases (7.2%). Only paroxysmal AF episodes were observed. Elderly donors and acute rejection resulted as risk factors in patients with post-operative AF episodes, who presented higher all-cause mortality at 11 years post-OHT (p < 0.001, Kaplan Meier analysis). The majority of late AF episodes occurred during hospitalization, due to renal failure or infections and more frequently in male patients; no significant correlation was observed with acute or chronic rejection or other characteristics. Conclusion: Pulmonary vein isolation and vagal denervation lead to low AF incidence in OHT recipients. Acute rejection and graft status are the main risk factors for post-operative AF episodes, while other systemic conditions act as late AF triggers. The occurrence of AF episodes is associated with poor outcome and AF should be considered as a marker of clinical frailty.
Long-term atrial arrhythmias incidence after heart transplantation
International Journal of Cardiology, 2020
Objectives. Atrial arrhythmias after heart transplantation have rarely been investigated. The aim of this study is to assess incidence, type and predictors of atrial arrhythmias during a long-term followup in a large population of heart-transplanted patients. Methods. Consecutive patients undergone to heart transplantation at our Centre from 1990 to 2017 were enrolled. All documented atrial arrhythmias were systematically reviewed during a long-term follow-up after heart transplantation. Atrial fibrillation (AF), atrial flutter and tachycardias were defined according to current guidelines. Results. Overall, 364 patients were included and followed for 120±70 months. During the followup period 108 (29.7%) patients died and 3 (0.8%) underwent re-transplantation. Sinus rhythm was present in 355 (97.5%) patients. Nine patients had persistent atrial arrhythmias: 8 (2.2%) presented atypical flutter and one (0.3%) patient AF. Paroxysmal sustained arrhythmias were detected in 42 (11.5%) patients, always atrial flutters. At univariate analysis several echocardiographic (left ventricular end-diastolic diameter, TEI index, mitral and tricuspid regurgitation grade) hemodynamic (systolic and diastolic pulmonary pressure, capillary wedge pressure) and clinical (dyslipidaemia, weight, pacemaker implantation) parameters related to higher incidence of atrial arrhythmias. Conclusion. Persistent atrial arrhythmias, and most of all AF, are rare among heart transplantation carriers, despite substantial comorbidities resulting in significant mortality. It can be speculated that the lesion set provided by the surgical technique, a complete and transmural electrical isolation of the posterior left atrium wall, represents an effective lesion set to prevent persistent AF.
The American Journal of Cardiology, 1992
ABSTRACT After orthotopic cardiac transplantation right bundle branch block (partial or complete) and left atrial (LA) enlargement (Figure 1) are often recognized electrocardiographically.1,2 Previously, a relation between electrocardiographic changes of LA enlargement and echocardiographic measurements of LA size has been established in the patient without cardiac transplantation.3,4 The structural significance of finding LA enlargement on a standard 12-lead electrocardiogram after cardiac transplantation has not been previously investigated, and forms the basis for the present study.