Background

Left atrial thrombus during pregnancy in mitral valve replacement status case is a rare condition. Large left atrial clots pose perioperative challenges like hemodynamic instability, arrhythmia, and thromboembolic events. We are going to describe the anesthetic management in a patient having a large left atrial thrombus.



Case presentation: We report a 25-year-old pregnant patient who presented at 19 weeks of her first pregnancy with breathing difficulty. The mitral valve replacement was done four years ago with a Medical mechanical heart valve for severe rheumatic mitral stenosis with pulmonary arterial hypertension. Although she had been prescribed anticoagulation medications post-surgery, She had discontinued them for past 2 months and subsequently presented with atrial fibrillation with a large left atrial clot. She underwent two emergency non-cardiac surgeries under general anesthesia.

Conclusions: We conclude that the post-mitral valve replacement status patient in cardiac failure with a large left atrial clot and atrial fibrillation requires immediate and aggressive medicinal or surgical care due to the life-threatening nature of the situation.