Altered fibrinocoagulation and intracardiac rheology in atrial fibrillation: Visualization of a complex hydrodynamic concept

A 77 year old female with a medical history remarkable for chronic atrial fibrillation, status post mitral, aortic valve replacement presented with suppuration and tenderness of a nonhealing ulcer of the left elbow of one month duration. On admission, the patient had fever, shortness of breath, and dyspnea on exertion of two weeks duration. A transesophageal echocardiogram revealed fibrillar echo densities suggestive of vegetations attached to both mitral and aortic bioprostheses. In addition, an impressive amount of spontaneous echo contrast within the markedly dilated left atrium and a massive echo density measuring 5.5 X 5.5 cm, which were significant phenomena found under conditions of slow blood flow, were clearly identified. This case illustrates how the complex hydrodynamic imbalance of atrial fibrillation may be associated with clot formation, despite adequate anticoagulation. (C) 2000 by Le Jacq Communications, Inc.