Rheumatic heart disease is rampant in India. Advanced forms of mitral stenosis are still common.
Critical mitral stenosis with LA clot formation is often seen.
But here is a women in late twenties presenting for the first time with syncope .
And what you see inside is not a fiction . . .
Left atrial clot occupying the whole cavity ! Where is the blood bound for left ventricle ?
4 chamber view
Luckily the clot is so big and MVO is less than 1 sq cm. It is highly unlikely the LA clot can negotiate the orifice.
Small fragments can dislodge .This patient developed syncope whenever she bends and lie down at a particular position.
What needs to be done in this patient ?
Can it be lysed ? No ,Emergency surgery is required with concomitant mitral valvotomy or mitral valve replacement.
Is there a temporary aortic filter available to prevent systemic emboli from heart ?
Distal protection devices are available only temporarily in the coronaries and carotids during interventional procedures.There is no aortic protection devices for LA,LV clots in high risk patients . When IVC filters are used block a potential pulmonary clot why not aortic filters for preventing systemic emboli ?
Why we have not thought about this . . . is surprising . May be intensive anti coagulation is as effective .
Dr.S.Venkatesan MD 