Frequency and Significance of Right Atrial Appendage Thrombi in Patients with Persistent Atrial Fibrillation or Atrial Flutter

Cresti, Alberto; Ma, García-Fernández; Miracapillo, Gennaro; Picchi, Andrea; Cesareo, F.; Guerrini, Francesco; Severi, Silva

doi:10.1016/j.echo.2014.08.008

Cited by 37 publications

(29 citation statements)

References 26 publications

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“…In contrast, the formation of a RAA thrombus is relatively rare, at 0.8-6 % [1][2][3][4], and few cases of bilateral appendage thrombosis have been reported [1]. In our case, the size of the RAA thrombus (3.39 9 2.01 cm) was larger than that of the LAA thrombus (2.53 9 1.26 cm), and this finding coincides with the previous report [1].…”

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Bilateral atrial appendage thrombus formation in a patient with atrial fibrillation

et al. 2015

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A 60-year-old Japanese man without obvious past medical history was referred to our hospital because of dyspnea. An electrocardiogram revealed atrial fibrillation (AF) without ST-T change, and a chest X-ray showed mild pulmonary congestion and bilateral pleural effusion. Two-dimensional transthoracic echocardiography (2D TTE) on admission showed markedly reduced left ventricular systolic function (LVEF) of 19 % and enlarged heart chambers ( Fig. 1a, b). We detected a left atrial appendage thrombus (Fig. 1c). 2D transesophageal echocardiography (2D TEE) was additionally performed to prepare for electrical cardioversion, and incidentally identified mobile thrombi in both the left atrial appendage (LAA) and right atrial appendage (RAA) ( Fig. 2a-d). The patient underwent emergency prophylactic surgical resection of bilateral thrombi in order to prevent systemic and pulmonary embolism. The surgical procedure removed both LAA and RAA with thrombi. In addition, the ''Maze'' procedure was performed for the treatment of atrial fibrillation. Pathological findings showed a mixture of old and freshly organized thrombus in the LAA. On the other hand, the RAA thrombus mainly consisted of fresh thrombus (Fig. 3).In the present case, we were able to visualize both left and right appendage thrombi using 3D TEE. This is the first report of 3D TEE images of bilateral atrial thrombi.Thrombus formation in LAA is a common complication in patients with AF, and its incidence is quoted as 12-15 %. In contrast, the formation of a RAA thrombus is relatively rare, at 0.8-6 % [1-4], and few cases of bilateral appendage thrombosis have been reported [1]. In our case, the size of the RAA thrombus (3.39 9 2.01 cm) was larger than that of the LAA thrombus (2.53 9 1.26 cm), and this finding coincides with the previous report [1]. In addition, LV systolic dysfunction (reduced LVEF) is a risk factor for LV and LAA thrombus formation. A previous report suggested that LV end-diastolic diameter was correlated with LAA thrombus formation [5]. On the other hand, moderate to severe mitral regurgitation (MR) has been recognized as a negative predictor for the development of a left atrial thrombus [6,7]. The severity of MR was mild in our case.We should pay attention to thrombus formation in not only the left but also the right atrial appendage, especially in patients with AF and reduced LV systolic function. Recently, real-time three-dimensional (3D) TEE has been a & Koichiro Imai

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confidence: 86%

Bilateral atrial appendage thrombus formation in a patient with atrial fibrillation

et al. 2015

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“…However there is no specific mention for RA or RAA evaluation. 10 Our patient presented with severe mitral stenosis and long standing AF and had simultaneous biatrial appendage clots. Such patients are at high risk of thromboembolism to systemic and pulmonary circulations.…”

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confidence: 78%

Biatrial appendages clots in a rheumatic heart disease patient – an important lesson to remember

Gupta¹,

Shewale²,

Sadananda³

et al. 2016

JCDR

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A 39 years lady presented with 6 months history of NYHA class II fatigue and dyspnea. On clinical examination she had irregular pulse, loud and variable S1, loud P2 and a mid-diastolic murmur in mitral area. A 12 lead ECG revealed atrial fibrillation. Transthoracic echocardiogram showed severe mitral stenosis with valve area of 1.0 cm2 and mild mitral regurgitation. The patient was planned for Balloon mitral valvotomy. Prior to the procedure, transesophageal echocardiogram (TEE) was done to rule out clots. TEE revealed dilated left atrium (LA) while left atrial appendage (LAA) had a 17 x 10mm clot (Figure 1A). LAA velocity was reduced (Figure 2). The Right atrial appendage (RAA) also had a clot measuring 18 x 12mm (Figure 1B). Patient had mild mitral regurgitation. In view of biatrial appendages clots, oral anticoagulation with warfarin was advised and balloon valvotomy was deferred.

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“…Also, AF does not confer the same risk of thrombus in the RAA as in the LAA, as the incidence of RAA thrombus is much lower than that of LAA thrombus (0.73% vs 9.3%, respectively; P < .01). 5 The incidence of AF in our population increased slightly during the study period (from 10% to approximately 12%) (Fig 1). 1…”

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confidence: 71%

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Rossi

et al. 2019

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Frequency and Significance of Right Atrial Appendage Thrombi in Patients with Persistent Atrial Fibrillation or Atrial Flutter

Cited by 37 publications

References 26 publications

Bilateral atrial appendage thrombus formation in a patient with atrial fibrillation

Bilateral atrial appendage thrombus formation in a patient with atrial fibrillation

Biatrial appendages clots in a rheumatic heart disease patient – an important lesson to remember

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