scholarly journals Animal model of left atrial thrombus in congestive heart failure in rats

2019 ◽  
Vol 317 (1) ◽  
pp. H63-H72
Author(s):  
Jiqiu Chen ◽  
Benjamin Strauss ◽  
Lifan Liang ◽  
Roger J. Hajjar
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Cardiac Function ◽  
Pulmonary Edema ◽  
Left Atrial ◽  
Left Ventricular ◽  
Left Atrial Thrombus ◽  
Aortic Banding ◽  
Atrial Thrombus ◽  
Fibrin Adhesion

The aim of the present study was to develop and study a new model of left atrial thrombus (LAT) in rat with congestive heart failure (CHF). CHF was induced by aortic banding for 2 mo, followed by ischemia-reperfusion (I/R) and subsequent aortic debanding for 1 mo. Cardiac function and the presence of LAT were assessed by echocardiography. Masson’s staining was performed for histological analysis. All CHF rats presented with significantly decreased cardiac function, fibrosis in remote myocardium, and pulmonary edema. The incidence rate of LAT was 18.8% in the rats. LAT was associated with severity of aortic constriction, aortic pressure gradient, aortic blood flow velocity, and pulmonary edema but not myocardial infarction or a degree of left ventricular depression. The progressive process of thrombogenesis was characterized by myocyte hypertrophy, fibrosis, and inflammation in the left atrial wall. Fibrin adhesion and clot formation were observed, whereas most LAT presented as a relatively hard “mass,” likely attributable to significant fibrosis in the middle and outer layers. Some LAT mass showed focal necrosis as well as fibrin bulging. Most LAT occurred at the upper anterior wall of the left atrial appendage. Aortic debanding had no significant impact on large LATs (>5 mm2) that had formed, whereas small LATs (<5 mm2) regressed 1 mo after aortic release. LAT is found in a rat model of aortic banding plus I/R followed by aortic debanding. The model provides a platform to study molecular mechanisms and potential new pathways for LAT treatment. NEW & NOTEWORTHY It is critically important to have a rodent model to study the molecular mechanism of thrombogenesis in the left atrium. Left atrial thrombus (LAT) is not a simple fibrin clot like those seen in peripheral veins or arteries. Rather, LAT is a cellular mass that likely develops in conjunction with blood clotting. Studying this phenomenon will help us understand congestive heart failure and promote new therapies for LAT.

scholarly journals Predictors of Left Atrial Thrombus and Short-Term Recurrence of Arrhythmia in Patients Undergoing Electrical Cardioversion for Atrial Fibrillation, a Single-Centre Experience

2017 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congestive Heart Failure ◽  
Left Atrial ◽  
Thrombus Formation ◽  
Electrical Cardioversion ◽  
Left Atrial Thrombus ◽  
Atrial Volume ◽  
Short Term ◽  
Atrial Thrombus

Background: Systemic thromboembolism is a serious complication of electrical cardioversion. Even in the absence of such complications there exists a significant rate of arrhythmia recurrence post cardioversion. Aims: The aim of this study was to identify factors that may aid clinicians in identifying those patients at increased risk of atrial thrombus formation and short-term arrhythmia recurrence. Methods: One-hundred and twelve patients were retrospectively identified across a 2.5 year period as having undergone electrical cardioversion at the Gold Coast University Hospital for atrial fibrillation or atrial flutter. Demographic, clinical and echocardiogram data was analysed to identify potential predictors of thrombus, unsuccessful cardioversion and arrhythmia recurrence. Results: Cardioversion was successful in 87.6% of patients. Cardioversion was more successful initially in males (p<0.01) and those with reduced atrial volume (p<0.01) and higher left ventricular ejection fraction (p<0.01). Arrhythmia recurrence within 3 months occurred in 57.7% of patients. Recurrence was more likely in those with congestive heart failure (p<0.05) and a longer pre-cardioversion duration of arrhythmia (p<0.05). Spontaneous echo contrast was observed in 3 (2.6%) of patients, whilst left atrial thrombus was observed in 7 (6.2%) of patients. Potential predictors of thrombus were congestive heart failure (p<0.05) and increased left atrial volume (p<0.01). Conclusions: This retrospective study identified a number of factors that may useful in the clinical setting in predicting cardioversion success, both initially and short-term, in addition to predicting thrombus formation.

scholarly journals Safe Technique of Removal of Left Atrial Thrombus during Mitral Valve Replacement Surgery

2016 ◽  
Vol 31 (1) ◽  
pp. 26-28
Author(s):  
Rampada Sarker ◽  
Manoz Kumar Sarker ◽  
AM Asif Rahim ◽  
Abdul Khaleque Beg
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Left Atrial ◽  
Left Ventricular ◽  
Left Ventricular Cavity ◽  
Safe Procedure ◽  
Left Atrial Thrombus ◽  
Atrial Thrombus ◽  
Ventricular Cavity

Background: Open mitral operation in patients with massive left atrial thrombus still with high mortality due to intra-operative embolism. To prevent this mortality due to intra-operative embolism and to prevent this danger we practiced a surgical technique which includes careful handling of heart and obliteration of left ventricular cavity by bilateral compression.Method: We used this technique in patients of severe mitral stenosis with atrial thrombus during mitral valve replacement. Our technique was to obliterate the left ventricular cavity and thus keep the mitral cusps in a coapted position by placing gauge posterior to left ventricle and a compression over right ventricle by hand of an assistant with a piece of gauze. This obliteration prevented passage of fragments of left atrial thrombus towards collapsed left ventricle.Result: Before practicing this technique, 4 out 9 patients expired due to cerebral embolism . But after implementation of this technique in 17 patients no mortality or morbidity occurred.Conclusion: This technique of removal of left atrial thrombus during mitral valve replacement may be a safe procedure for preventing peroperative embolism.Bangladesh Heart Journal 2016; 31(1) : 26-28

scholarly journals Myocardial Infarction in Neonates: A Diagnostic and Therapeutic Challenge

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Manuel Rodríguez Martínez ◽  
Eladio Ruiz González ◽  
Anna Parra-Llorca ◽  
Máximo Vento Torres ◽  
Marta Aguar Carrascosa
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Congestive Heart Failure ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Cardiac Enzymes ◽  
Term Baby

Neonatal acute myocardial infarction is an uncommon entity. We describe the case of a 4-day-old term baby who presented with respiratory distress and distal acrocyanosis. The chest radiograph demonstrated cardiomegaly without pleural effusion, and examination revealed hepatomegaly. An electrocardiogram revealed QS pattern in leads I, aVL, and V6, suggestive of ischemia. Cardiac enzymes were elevated, and echocardiogram revealed moderate left ventricular dysfunction with a thrombus at the level of the left atrial appendage. The patient required hemodynamic stabilization, vasodilatation to avoid congestive heart failure, and anticoagulation with heparin and aspirin. In the context of this unusual diagnosis, we reviewed our experience over the last 17 years as well as the existing literature on neonatal myocardial infarction.

scholarly journals Association of CHADS2and CHA2DS2-VASc Scores with Left Atrial Thrombus with Nonvalvular Atrial Fibrillation: A Single Center Based Retrospective Study in a Cohort of 2695 Chinese Subjects

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
J. Huang ◽  
SL. Wu ◽  
YM. Xue ◽  
HW. Fei ◽  
QW. Lin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Area Under The Curve ◽  
Predictive Ability ◽  
Left Ventricular ◽  
Left Atrial Thrombus ◽  
Nonvalvular Atrial Fibrillation ◽  
Atrial Thrombus

The main mechanism of the CHADS2and CHA2DS2-VASc scores to predict stroke in nonvalvular atrial fibrillation (NVAF) is still controversial. We evaluated the association of the CHADS2and CHA2DS2-VASc scores with left atrial thrombus (LAT) as detected by transesophageal echocardiographic (TEE) and compared the predictive ability of these risk stratification schemes with nonvalvular atrial fibrillation (NVAF). Data from 2,695 consecutive NVAF patients in whom TEE was performed for screening LAT from July 2007 to February 2014 were analyzed. Only 3% of the subjects had LAT. Presence of LAT was not significantly associated with either CHADS2  (P=0.07)or CHA2DS2-VASc score(P=0.12). The area under the curve (AUC) concerning LAT prediction using CHADS2and CHA2DS2-VASc was 0.574 and 0.569, respectively. A composition model includes previous stroke or transient ischemic attack, nonparoxysmal AF, moderate to severe left ventricular systolic dysfunction, left atrial enlargement, and cardiomyopathy which improved the discrimination significantly (AUC = 0.743). In our cohort, both CHADS2and CHA2DS2-VASc scores were of limited value for predicting LAT in patients with NVAF. This questions the CHADS2/CHA2DS2-VASc score predicting stroke mainly through the mechanism of cardiogenic embolism. A scoring scheme combining clinical and echocardiographic parameters may better predict LAT as a surrogate for cardioembolic risk in NVAF patients.

scholarly journals Blood Stasis Secondary to Heart Failure Forms Warfarin-Resistant Left Atrial Thrombus

2014 ◽  
Vol 55 (6) ◽  
pp. 506-511 ◽  
Author(s):  
Atai Watanabe ◽  
Naohide Yamashita ◽  
Takeshi Yamashita
Keyword(s):  
Heart Failure ◽  
Left Atrial ◽  
Blood Stasis ◽  
Left Atrial Thrombus ◽  
Atrial Thrombus

scholarly journals Left atrial thrombus formation within a few days of hospitalization in semi-acute ischemic heart disease despite no atrial fibrillation and mitral stenosis: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Keiko Okamura ◽  
Mitsuharu Kodaka ◽  
Junko Ichikawa ◽  
Kazuyoshi Ando ◽  
Makiko Komori
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Mitral Stenosis ◽  
Left Atrial ◽  
Thrombus Formation ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Left Atrial Thrombus ◽  
Atrial Thrombus ◽  
Heparin Resistance

Abstract Background Currently, the occurrence of left atrial thrombus despite the provision of heparinization within a few days of hospitalization without atrial fibrillation (AF) and mitral stenosis (MS) is rarely reported. Case presentation A 71-year-old woman presented with chest discomfort and dyspnea. Examination revealed ST elevation with sinus rhythm, congestive heart failure, and moderate mitral regurgitation (MR) by transthoracic echocardiography (TTE). Diuretics, a coronary vasodilator, and unfractionated heparin (15,000 units/day) were administered. Four days after hospitalization, her C-reactive protein level had increased; therefore, TTE was repeated, revealing a thrombus in the left atrial appendage, which was probably affected by heparin resistance because of low antithrombin (49%). On day 5, the patient underwent emergency removal of the thrombus, mitral valve replacement, and coronary artery bypass. Conclusion Patients can exhibit low left ventricular contractility, even sinus rhythm without MS. Thus, TTE and subsequent coagulation tests including antithrombin must be performed to prevent thrombus.

Association of Thromboembolic Risk Score with Left Atrial Thrombus and Spontaneous Echocardiographic Contrast in Non-Anticoagulated Nonvalvular Atrial Fibrillation Patients

Cardiology ◽  
2018 ◽  
Vol 140 (2) ◽  
pp. 87-95 ◽  
Author(s):  
Jun Huang ◽  
Hong-tao Liao ◽  
Hong-wen Fei ◽  
Yu-mei Xue ◽  
Li Zhang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Scoring System ◽  
Left Atrial ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Left Atrial Thrombus ◽  
Nonvalvular Atrial Fibrillation ◽  
Atrial Thrombus ◽  
Ventricular Ejection Fraction ◽  
New Scoring

Objectives: The aim of the study was to examine the association of CHADS2/CHA2DS2-VASc scores with left atrial thrombus (LAT) and spontaneous echocardiographic contrast (SEC) in non-anticoagulated nonvalvular atrial fibrillation (NVAF) spontaneous patients, and to develop a new scoring system for LAT/SEC prediction. Methods: Consecutive non-anticoagulated NVAF patients with or without LAT/SEC by transesophageal echocardiography were identified in the Guangdong General Hospital. Results: Among 2,173 patients, the prevalence of LAT/SEC was 4.9%. Both predictive values of CHADS2 and CHA2DS2-VASc scores for the presence of LAT/SEC were low-to-moderate (receiver operating characteristic [ROC] = 0.591 and 0.608, respectively, p = 0.90). By multivariate analysis, non-paroxysmal AF, decreased left ventricular ejection fraction, and left atrial enlargement were positively associated with LAT/SEC, while CHADS2/CHA2DS2VASc scores were not. A new scoring system based on these 3 factors above significantly improved the discrimination for LAT/SEC (ROC = 0.792). Conclusions: CHADS2/CHA2DS2-VASc scores had limited value in predicting LAT/SEC; a new scoring system that combines AF type and echocardiographic parameters may better predict LAT/SEC as a surrogate for cardioembolic risk in NVAF patients.

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