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Nearly all left atrial thrombi may be extended from pulmonary vein thrombi
IJC Heart & Vasculature 7 (2015) 9
Contents lists available at ScienceDirect
IJC Heart & Vasculature journal homepage: http://www.journals.elsevier.com/ijc-heart-and-vasculature
Nearly all left atrial thrombi may be extended from pulmonary vein thrombi
treatment, and thus, more efficient anti-coagulants are needed to prevent ischemic stroke.
Keywords: Pulmonary vein thrombus 64-MDCT Left atrial thrombus Stroke
Conflict of interest
Ischemic stroke is a serious clinical problem [1,2]. To prevent ischemic stroke, it is crucial to identify clinical targets. Left atrial thrombus is a known cause of ischemic stroke [2,3]; however, the cause of left atrial thrombus remains unknown. Pulmonary vein thrombosis (PVT) is thought to be rare; however, I have published several cases of PVT in elderly patients with chest pain using a 64-slice multidetector CT (64-MDCT) since 2012 [4–10]. In 2014, I reported that 61% (35 patients) of 57 elderly patients with chest pain had PVT, as assessed using 64-MDCT, which suggests that PVT is common in elderly patients with chest pain [9]. Although I have reported that a thrombus in the pulmonary vein extends into the left atrium [5,6,8,9], the relationship between PVT and a left atrial thrombus remains unknown. I reviewed the images of 64-MDCT scans obtained from 35 patients with PVT. Seventeen patients (49%) had a thrombus in the left atrium, which was extended from pulmonary vein thrombi, indicating that approximately half of patients with PVT had a left atrial thrombus. In addition, among the 22 patients without PVT, only three patients (14%) had a left atrial thrombus. These three patients may have a fine pulmonary vein thrombus, which could not be clearly visualized using 64-MDCT. Thus, there is a possibility that nearly all left atrial thrombi are extended from pulmonary vein thrombi. Nearly all left atrial thrombi may use pulmonary vein thrombi as a root, which may provide a strong structure in the thrombi. In addition, I reported that some of the thrombi were partially dissolved within three months following warfarin [4] and dabigatran [7–9] treatment, indicating that warfarin and dabigatran could prevent ischemic stroke by dissolving the pulmonary vein thrombus and the connected left atrial thrombus. However, not all thrombi were dissolved upon warfarin [5] and dabigatran [10]
The authors report no relationships that could be construed as a conflict of interest. References [1] Strong K, Mathers C, Bonita R. Preventing stroke: saving lives around the world. Lancet Neurol 2007;6:182–8. [2] Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991;22:983–8. [3] Blackshear JL, Odell JA. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg 1996;61:755–9. [4] Takeuchi H. A thrombus of the right upper pulmonary vein: detection by the use of a 64-MDCT. BMJ Case Rep Sep 14 2012. http://dx.doi.org/10.1136/bcr.12.2011.5446 [Published online:]. [5] Takeuchi H. 64-MDCT scan demonstrated pulmonary vein thrombus. J Neurol Neurophysiol 2013;S8:002. http://dx.doi.org/10.4172/2155-9562.S8-002. [6] Takeuchi H. 64-MDCT can depict the thrombi expanded from the left lower pulmonary vein to the left atrium in the patient with angina pectoris. BMJ Case Rep Apr 3 2013. http://dx.doi.org/10.1136/bcr.2013-008750 [Published online:]. [7] Takeuchi H. Floating thrombus in the left upper pulmonary vein dissolved by dabigatran. BMJ Case Rep Oct 9 2013. http://dx.doi.org/10.1136/bcr-2013-200836 [Published online:]. [8] Takeuchi H. Chest pain caused by pulmonary vein thrombi could be curable by dabigatran. BMJ Case Rep March 13 2014. http://dx.doi.org/10.1126/bcr-2013203186 [Published online:]. [9] Takeuchi H. High prevalence of pulmonary vein thrombi in elderly patients with chest pain, which has relationships with aging associated diseases. IJC Heart Vessels 2014;4:129–34. http://dx.doi.org/10.1016/j.ijchv.2014.05.006 [Published online: 6-JUN-2014]. [10] Takeuchi H. Pulmonary vein thrombi in a patient with paroxysmal atrial fibrillation. IJC Heart Vasculature 2014;5:63–4. http://dx.doi.org/10.1016/j.ijcha.2014.10.006.
Hidekazu Takeuchi Nagasaki-ken Tomie Hospital, 499 Tomie-chou, Goto-city, Nagasaki 853-0205, Japan Tel.: +81 959 86 1121; fax: +81 959 86 0400. E-mail address: [email protected]. 24 January 2015
http://dx.doi.org/10.1016/j.ijcha.2015.01.013 2352-9067/© 2015 The Author. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Contents lists available at ScienceDirect
IJC Heart & Vasculature journal homepage: http://www.journals.elsevier.com/ijc-heart-and-vasculature
Nearly all left atrial thrombi may be extended from pulmonary vein thrombi
treatment, and thus, more efficient anti-coagulants are needed to prevent ischemic stroke.
Keywords: Pulmonary vein thrombus 64-MDCT Left atrial thrombus Stroke
Conflict of interest
Ischemic stroke is a serious clinical problem [1,2]. To prevent ischemic stroke, it is crucial to identify clinical targets. Left atrial thrombus is a known cause of ischemic stroke [2,3]; however, the cause of left atrial thrombus remains unknown. Pulmonary vein thrombosis (PVT) is thought to be rare; however, I have published several cases of PVT in elderly patients with chest pain using a 64-slice multidetector CT (64-MDCT) since 2012 [4–10]. In 2014, I reported that 61% (35 patients) of 57 elderly patients with chest pain had PVT, as assessed using 64-MDCT, which suggests that PVT is common in elderly patients with chest pain [9]. Although I have reported that a thrombus in the pulmonary vein extends into the left atrium [5,6,8,9], the relationship between PVT and a left atrial thrombus remains unknown. I reviewed the images of 64-MDCT scans obtained from 35 patients with PVT. Seventeen patients (49%) had a thrombus in the left atrium, which was extended from pulmonary vein thrombi, indicating that approximately half of patients with PVT had a left atrial thrombus. In addition, among the 22 patients without PVT, only three patients (14%) had a left atrial thrombus. These three patients may have a fine pulmonary vein thrombus, which could not be clearly visualized using 64-MDCT. Thus, there is a possibility that nearly all left atrial thrombi are extended from pulmonary vein thrombi. Nearly all left atrial thrombi may use pulmonary vein thrombi as a root, which may provide a strong structure in the thrombi. In addition, I reported that some of the thrombi were partially dissolved within three months following warfarin [4] and dabigatran [7–9] treatment, indicating that warfarin and dabigatran could prevent ischemic stroke by dissolving the pulmonary vein thrombus and the connected left atrial thrombus. However, not all thrombi were dissolved upon warfarin [5] and dabigatran [10]
The authors report no relationships that could be construed as a conflict of interest. References [1] Strong K, Mathers C, Bonita R. Preventing stroke: saving lives around the world. Lancet Neurol 2007;6:182–8. [2] Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991;22:983–8. [3] Blackshear JL, Odell JA. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg 1996;61:755–9. [4] Takeuchi H. A thrombus of the right upper pulmonary vein: detection by the use of a 64-MDCT. BMJ Case Rep Sep 14 2012. http://dx.doi.org/10.1136/bcr.12.2011.5446 [Published online:]. [5] Takeuchi H. 64-MDCT scan demonstrated pulmonary vein thrombus. J Neurol Neurophysiol 2013;S8:002. http://dx.doi.org/10.4172/2155-9562.S8-002. [6] Takeuchi H. 64-MDCT can depict the thrombi expanded from the left lower pulmonary vein to the left atrium in the patient with angina pectoris. BMJ Case Rep Apr 3 2013. http://dx.doi.org/10.1136/bcr.2013-008750 [Published online:]. [7] Takeuchi H. Floating thrombus in the left upper pulmonary vein dissolved by dabigatran. BMJ Case Rep Oct 9 2013. http://dx.doi.org/10.1136/bcr-2013-200836 [Published online:]. [8] Takeuchi H. Chest pain caused by pulmonary vein thrombi could be curable by dabigatran. BMJ Case Rep March 13 2014. http://dx.doi.org/10.1126/bcr-2013203186 [Published online:]. [9] Takeuchi H. High prevalence of pulmonary vein thrombi in elderly patients with chest pain, which has relationships with aging associated diseases. IJC Heart Vessels 2014;4:129–34. http://dx.doi.org/10.1016/j.ijchv.2014.05.006 [Published online: 6-JUN-2014]. [10] Takeuchi H. Pulmonary vein thrombi in a patient with paroxysmal atrial fibrillation. IJC Heart Vasculature 2014;5:63–4. http://dx.doi.org/10.1016/j.ijcha.2014.10.006.
Hidekazu Takeuchi Nagasaki-ken Tomie Hospital, 499 Tomie-chou, Goto-city, Nagasaki 853-0205, Japan Tel.: +81 959 86 1121; fax: +81 959 86 0400. E-mail address: [email protected]. 24 January 2015
http://dx.doi.org/10.1016/j.ijcha.2015.01.013 2352-9067/© 2015 The Author. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).