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A 62-year-old female patient with history of atrial fibrillation and protein C and S deficiency was admittedfor acute dyspnea. Laboratory control demonstrated an unregulated warfarin treatment. Transthoracicechocardiography and computed tomography revealed a giant left atrial thrombus and a severe mitralstenosis. The day after admission a full body tomography revealed spleen emboli and non-violation ofhematoencephalic barrier. Surgical thrombus extraction and mitral valve replacement were successfullyperformed by minimal invasive, partially video-assisted, right anterolateral thoracotomy.Echocardiographic control after two months showed no evidence of residual thrombus. Massive left atrialthrombosis must be operated urgently because of the imminent risk of embolization. The describedtechnique represents a good compromise between full video-assisted port-access surgery and traditionalmidline sternotomy.

journal of integrative cardiology open access

Extraction through Minimal Invasive Partially Video-Assisted Anterolateral Right Thoracotomy of a Voluminous Left Atrial Thrombus Due to Unregulated Warfarin Treatment