Acute mesenteric ischemia due to left atrial movable thrombi in a patient with mitral valve replacement

Background: Mesenteric ischemia associated with left atrial thrombosis is a serious complication that can occur after a mechanical mitral valve replacement. We performed an operation to remove the atrial thrombi leading to acute mesenteric ischemia. Possible cause of this thrombi formation is discussed. Case Report: A 47-year-old woman was transferred to our hospital for investigation of mesenteric ischemia thought to be cardiogenic in origin, 3 years after mitral valve replacement. She was initially admitted to Department of General Surgery after sudden abdominal pain and a diagnosis of mesenteric ischemia was made. The transesophageal echocardiogram showed a mechanical mitral valve and oscillating thrombi on the left atrium. The patient subsequently underwent an urgent open heart operation. The left atrial thrombi were removed without valve re-replacement. Histopathological study results of the operative specimen were consistent with thrombus. She had an uneventful postoperative recovery and was discharged from hospital 16 days after operation in good condition. Conclusions: We believe that the mesenteric thromboembolism was most likely caused by oscillating atrial thrombi due to inappropriate warfarin use and atrial fibrillation. Therefore, life-time follow-up and appropriate anticoagulant therapy is recommended to prevent thromboembolic events after the mechanical mitral valve replacement.