Clinics of Surgery Case Report ISSN 2638-1451 Volume 3 Large Lef Atrial Trombus Under Oral Anticoagulation Terapy with Rivaroxiban Nader J, Nzomvuama A and Remadi JP * Cardio-vascular surgery unit, Amiens university Hospital, France *Corresponding author: REMADI Jean-Paul, Cardiovascular surgery unit, South Hospital, Amiens, France, Tel: +3364630383, FAX +3332245531, E-mail: jpvmrema@gmail.com Received: 19 Oct 2020 Accepted: 02 Nov 2020 Published: 06 Nov 2020 Keywords: Anticoagulation; Trombus; Cardiac-Surgery Copyright: ©2020 Remadi JP et al. Tis is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commer- cially. Citation: Remadi JP, Large Lef Atrial Trombus Under Oral Anticoagulation Terapy with Rivaroxiban. Clinics of Surgery. 2020; 3(5): 1-3. 1. Abstract A 75 years old male patient, had a lower limb phlebitis treated by Rivaroxiban, presented an increasing dyspnea. A Doppler echogra- phy found a lef sural deep venous thrombosis (DVT). Te Trans- thoracic and transesophageal echocardiography found a large lef atrial tumor, moving randomly across the mitral valve, 100 mm of length and going until the lef ventricular apex (Figure 1). Te surgical procedure was performed, 24 hours afer Rivaroxiban’s in- terruption. Te microscopic examination of the mass confrmed thrombus nature of this appendage. Te patient was discharged 8 days later with efcient oral anticoagulation with oral Coumadin. Te one-year follow-up was uneventful. 2. Case Report Atrial thrombus and atrial tumors are the two most frequent en- tities when a large appendage in the lef atrium is discovered on echocardiography. In term of morphology and mobility, the two entities are un-diferentiable. We report here the case of a large lef atrial thrombus, considered initially as a large atrial myxoma, in a 75-year-old patient. A 75 years old male patient, with an history of mellitus diabetes, dyslipidemia and lower limb phlebitis treated by Rivaroxiban, pre- sented an increasing dyspnea leading him to have a check-up at his cardiologists’. He presented an exercise dyspnea associated to an asymmetric calf perimeter. A Doppler echography found a lef sural deep venous thrombosis (DVT) associated with a biological infammatory syndrome. ECG showed sinus rhythm. Te Transthoracic and trans esophageal echocardiography found a large lef atrial tumor, moving randomly across the mitral valve, 100 mm of length and 8 to 10 mm of diameter, and going until the lef ventricular apex (Figure 1). Te mitral valve was normal. An atrial myxoma was then suggested. Te coagulation factors were normals. Te blood level of Rivaroxiban was not evaluated. An ab- dominal CT-scan revealed large areas of kidney’s infarctions, com- patible with a systemic embolic migration. Afer 48 hours of non-efective anticoagulation therapy, a surgical management was decided and the patient transferred in our de- partment. Te surgical procedure was performed, 24 hours afer Rivarox- iban’s interruption, under cardiopulmonary bypass(CPB). Af- ter aortic cross-clamping, and when the lef pulmonary vein was opened for the lef ventricular vent, the tumor was spontaneously ejected through the superior pulmonary vein orifce. Macroscop- ically, the mass looked like being an atrial thrombus. Te mitral valve appeared normal. We decided to approach the right atrium and founded the thrombus stump appended to a patent septal fo- ramen ovalis (Figure 2). Te communication was closed and the atrial septal aneurysm was plicatured. Te patient did not need any blood transfusion. Te microscopic examination of the mass confrmed its bloody or- igin. https://clinicsofsurgery.com/ 1