Forgotten, but Not Gone

Abstract

A 65 year old woman, an Asian immigrant to USA, with the history of surgical mitral
valvuloplasty through left thoracotomy performed 30 years ago in India for severe rheumatic
mitral stenosis, history of embolic occlusion of right femoral artery and surgical embolectomy
(3 years ago), chronic atrial fibrillation, presented with dyspnea on exertion. Patient was on
Coumadin therapy with therapeutic INR (2-3). Her work up revealed severe mitral stenosis
with marked left atrial enlargement. There was massive clot burden in the left atrium. Despite
massive left atrial clot, patient had no history of stroke/TIA. She then successfully underwent
left atrial thrombectomy with mitral valve replacement. Intra operative findings were very
small orifice of mitral valve with fused commissures and chordae tendinae, consistent with
severe rheumatic mitral stenosis. Post-operative recovery was uneventful. Patient continues
on Coumadin with target INR of 2.5-3.5 with post-operative echocardiograms showing no left
atrial clot.