No abstract

Echocardiography showed a voluminous free-floating left atrial thrombus in an 80-year-old woman affected by rheumatic mitral stenosis with long-standing atrial fibrillation who was admitted because of transient left arm paralysis and drop attack without loss of conscience. She refused open heart surgery and was treated with warfarin. One month later echocardiography detected complete disappearance of the thrombus; no episodes of peripheral embolization had occurred since the beginning of medication with warfarin. According to this report, warfarin is a valuable alternative to surgical treatment for freefloating left atrial thrombi.

We describe a case of an infective right atrial thrombus, following total parenteral nutrition, in a 21-year-old woman undergoing a surgical procedure for long-standing chronic ulcerative colitis. She presented with high temperature and the illness did not respond to antibiotic therapy. A 2-dimensional echocardiogram showed a mobile right atrial mass that at surgery was identified as a thrombus. Thrombus cultures grew coagulase-negative Staphylococcus aureus.

Aging is one of the strongest risk factors for cardiovascular events and even elderly patients with established disease are likely to derive benefits from secondary prevention programs. Unfortunately, few clinical trials have been specificately addressed to older population. However, since this population is rising and presents with intrinsic characteristics, it is worthwhile to consider the problems of the elderly with a sociological and ethical approach too and not only from a medical point of view.

Atrial fibrillation is the most frequent complication after cardiac surgery. Its onset leads to a threefold higher risk for stroke compared with patients in sinus rhythm and other adverse events such as thromboembolic events and heart failure. The direct consequence is an increased length of hospital stays with obvious economic implications. These reasons have led the attention of many investigators to point out the rule of possible predisposing factors and underlining mechanisms in order to establish an effective preventive treatment. The present paper is aimed to review the state-of-the-art knowledge about post-operative atrial fibrillation and its complex etiopathogenesis which is in turn responsible for the lack of consensus regarding routine prophylaxis.