A 72-year-old woman with no notable medical history presented with leg edema and dyspnea. Chest radiography showed an enlarged heart and pleural effusion, and electrocardiogram revealed atrial fibrillation. The patient was diagnosed with worsening congestive heart failure associated with tachycardic atrial fibrillation. Coronary angiography demonstrated no significant stenosis of the coronary arteries to investigate the other causes of heart failure. However, we observed an anomalous direct inflow from the left coronary circumflex artery into the left atrial appendage (LAA) (Picture A, arrows). The contrast medium poured into the LAA remained stagnant, and a roundish structure was observed (Picture A, arrowheads). Although transthoracic echocardiography could not detect a thrombus in the LAA, transesophageal echocardiography (TEE) revealed it, and peak emptying velocity was markedly reduced to 9.97 cm/s (Picture B). Direct oral anticoagulation (DOAC) was administered, and cardiac computed tomography showed disappearance of the thrombus (Picture C, D). Although TEE is the gold standard for identifying LAA thrombi (1), this is the first case in which coronary angiography detected a thrombus in the LAA.
Picture.
The authors state that they have no Conflict of Interest (COI).
References
- 1.Melillo E, Palmiero G, Ferro A, Mocavero PE, Monda V, Ascione L. Diagnosis and management of left atrium appendage thrombosis in atrial fibrillation patients undergoing cardioversion. Medicina (Kaunas) 55: 511, 2019. [DOI] [PMC free article] [PubMed] [Google Scholar]