Surgical Removal of Left Atrial Appendage Thrombus in a Patient with Acute Ischemic Stroke.
His past medical history was significant for hypertension and seizure disorder. Initial vital signs were notable for an irregular pulse at 83 beats per minute and BP of 222/127 mm Hg. He was alert but could not speak. He had right-sided hemiparesis. CT brain without contrast was unremarkable without hemorrhage. He was not a candidate for thrombolytics due to delayed presentation. His malignant hypertension was managed with Labetalol drip. Electrocardiogram showed atrial fibrillation. MRI of the brain revealed multiple acute infarctions in left parietal and occipital lobes (Figure 1) along with small focus of petechial hemorrhagic conversion of left parietal infarcts.
Patient underwent surgical removal of LAA clot and resection of LAA (Figure 3) three days after
his presentation. With stability of the neurological findings and imaging, he was started on Heparin and Coumadin to decrease the risk of future cardioembolic stroke with chronic atrial fibrillation. Patient has residual aphasia and right hemiparesis. A study on a large series of patients with LAA thrombus on transesophageal echocardiogram showed increased risk of embolic events approximately 10.4% per year and mortality of 15.8% per year. Our patient presented with cardioembolic stroke due to large LAA thrombus with mobile elements and had evidence of several embolic strokes. The best timing for surgical removal of thrombus from LAA is unknown .
Heart Res Open J. 2015; 2(3): 100-102.doi: 10.17140/HROJ-2-117