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Case Report

JCDR. 2016; 7(3): 126-127

Biatrial appendages clots in a rheumatic heart disease patient – an important lesson to remember

Anshul Kumar Gupta, Sunil Dhondiram Shewale, Kanchanahalli Siddegowda Sadananda, Chollenahally Nanjappa Manjunath.


Patients with Atrial fibrillation (AF) are quite prone to develop atrial clots due to stasis from impaired atrial contractile
function. While left atrial (LA) and left atrial appendage (LAA) thrombi are quite common, right atrial (RA) and right atrial
appendage (RAA) clots are uncommonly seen. Structural and functional differences between RAA and LAA have been
implicated in lower prevalence of RAA clots in AF patients. We report here simultaneous LAA and RAA clots in a patient
with Rheumatic heart disease, mitral stenosis and Atrial fibrillation. Though current guidelines do not make a specific
mention of RAA assessment, we highlight the fact that a comprehensive echocardiographic evaluation of both atrial appendages
is of paramount importance in atrial fibrillation patients especially those who are planned to undergo balloon
mitral valvotomy or cardio version.

Key words: Right atrial appendage, Left atrial appendage, atrial fibrillation, Mitral stenosis, clot.

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