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| IMAGES IN CARDIOLOGY |
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| Year : 2022 | Volume
: 11
| Issue : 4 | Page : 105-106 |
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Coronary neovascularization due to left atrial thrombus in a patient with mitral and aortic valves stenosis: A forgotten sign
Ganeshrao Patilba Sapkal1, Satyavan Sharma2
1 Department of Cardiology, Government Medical College Hospital, Aurangabad, Maharashtra, India
2 Department of Cardiology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
| Date of Submission | 12-May-2022 |
| Date of Decision | 05-Sep-2022 |
| Date of Acceptance | 15-Nov-2022 |
| Date of Web Publication | 21-Jan-2023 |
Correspondence Address:
(MBBS, MD, DMCardiology) Ganeshrao Patilba Sapkal
Department of Cardiology, Government Medical College Hospital, Aurangabad - 431 001, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jcpc.jcpc_17_22
How to cite this article:
Sapkal GP, Sharma S. Coronary neovascularization due to left atrial thrombus in a patient with mitral and aortic valves stenosis: A forgotten sign. J Clin Prev Cardiol 2022;11:105-6 |
How to cite this URL:
Sapkal GP, Sharma S. Coronary neovascularization due to left atrial thrombus in a patient with mitral and aortic valves stenosis: A forgotten sign. J Clin Prev Cardiol [serial online] 2022 [cited 2023 Jun 8];11:105-6. Available from: https://www.jcpconline.org/text.asp?2022/11/4/105/368352 |
| Case Presentation | |  |
A 60-year-old female with rheumatic heart disease was admitted with dyspnea on exertion (NYHA class III) and intermittent palpitations for 2 years. Transthoracic echocardiography revealed atrial fibrillation with thickened mitral and aortic valves, critically severe mitral stenosis with a mitral valve area of 0.9 cm2 by planimetry and 1 cm2 by pressure half time. The peak/mean gradients across the mitral valve were 18/9 mmHg. There was moderate aortic stenosis with the peak/mean gradients across the aortic valve of 61/35 mmHg, moderate aortic regurgitation, and moderate tricuspid regurgitation. The left atrium (LA) was enlarged, measuring approximately 59 mm. A huge inhomogeneous thrombus extending from the left atrial appendage (LAA) into the LA, occupying its almost 2/3rd area [Figure 1], was noted. The patient was referred for double valvular surgery. Preoperative coronary angiography was performed, which revealed no obstructive atherosclerotic disease in the left anterior descending, left circumflex (LCx), and right coronary artery. Small branches from the left atrial branch of LCx and proximal LCx were seen coursing superiorly near the area of LA forming a capillary network and then draining into the LA. There were multiple small fistulas from the proximal segment and atrial branch of LCx coursing superiorly. It was suggestive of neovascularization in LA with fistula formation from LCx to LA [Figure 2]. During open heart surgery, LA and LAA were full of inhomogeneous, soft, and friable thrombus, which was removed completely [Figure 3] and subsequently, mitral commissurotomy with aortic valve replacement was done. The patient was stable and doing well even at follow-up. | Figure 1: Left coronary angiogram in (a) lateral and (b) RAO caudal view showing multiple fistula (neovascularization) from left circumflex in the region of the left atrium (arrow). RAO = Right anterior oblique
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 | Figure 2: Transthoracic echocardiography documents thrombus in the left atrium in (a) parasternal long-axis view and (b) apical four-chamber view (arrow)
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 | Figure 3: (a) Large thrombus visualized at surgery (arrow) after opening left atrium (b) Large thrombus removed from the left atrium
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Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
[Figure 1], [Figure 2], [Figure 3]
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