Giant left atrial thrombus in mild mitral stenosis without embolic complication
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Abstract:
While large left atrial mural thrombi are frequently occurred in moderate and severe mitral stenosis, left atrial thrombi are rarely seen in mild mitral stenosis.In this report we presented a case of 71-year-old woman with rheumatic mild mitral valve stenosis but had a giant left atrial thrombus derected by echocardiography.Keywords:
Mitral valve stenosis
Objective Application of color doppler ultrasound(CDFI) detection of the lower limbs of deep vein thrombosis(DVT) for the clinical stages,by the early identification and early treatment,reduce the incidence of pulmonary embolism or by the sudden death of pulmonary artery thrombosis cause blood clots and post-thrombotic syndrome. Methods Choose the 40 patients from the January of 2010 to the August of 2011.They are all the patients checked by CDFI and DSA,and diagnosed the patients who are vein thrombus in legs,including acute thrombus,subacute thrombus and chronic thrombus.Obserse the pictures of Color Doppler Flow Imaging. Results The showing of two dimensions color supersonic wave and the showing of CDFI has typical sound wave.The results after treating are different.The result of early acute thrombus(flowing back is not easy)is the best.The thrombus can be dissolved less than one month.The thrombus of the middle period and later period can be dissolved in 3 months.But the thrombus of subacute needs 3～6 months or more than 6 months to dissolve most of the thrombus.But we can still see the thrombus among the patients of the thrombus of the middle period and later period.We can see the organization echo wave of thrombus after 10 years in the chronic thrombus patients. Conclusion The treatment on acute thrombus patient is the best.The treatment on subacute thrombus patients is the second.The treatment on chronic thrombus patients is the worst.
Color doppler
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Abstract Thrombosis is a complex biological process which involves many biochemical reactions and is influenced by blood flow. Various computational models have been developed to simulate natural thrombosis in diseases such as aortic dissection (AD), and device-induced thrombosis in blood-contacting biomedical devices. While most hemodynamics-based models consider the role of low shear stress in the initiation and growth of thrombus, they often ignore the effect of thrombus breakdown induced by elevated shear stress. In this study, a new shear stress-induced thrombus breakdown function is proposed and implemented in our previously published thrombosis model. The performance of the refined model is assessed by quantitative comparison with experimental data on thrombus formation in a backward-facing step geometry, and qualitative comparison with in vivo data obtained from an AD patient. Our results show that incorporating thrombus breakdown improves accuracy in predicted thrombus volume and captures the same pattern of thrombus evolution as measured experimentally and in vivo. In the backward-facing step geometry, thrombus breakdown impedes growth over the step and downstream, allowing a stable thrombus to be reached more quickly. Moreover, the predicted thrombus volume, height and length are in better agreement with the experimental measurements compared to the original model which does not consider thrombus breakdown. In the patient-specific AD, the refined model outperforms the original model in predicting the extent and location of thrombosis. In conclusion, the effect of thrombus breakdown is not negligible and should be included in computational models of thrombosis.
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Mechanical thrombectomy (MT) for large vessel occlusion often requires multiple passes to retrieve the entire thrombus load. In this multi-institutional study we sought to examine the composition of thrombus fragments retrieved with each pass during MT.Patients who required multiple passes during thrombectomy were included. Histopathological evaluation of thrombus fragments retrieved from each pass was performed using Martius Scarlet Blue staining and the composition of each thrombus component including RBC, fibrin and platelet was determined using image analysis software.154 patients underwent MT and 868 passes was performed which resulted in 263 thrombus fragments retrieval. The analysis of thrombus components per pass showed higher RBC, lower fibrin and platelet composition in the pass 1 and 2 when compared to pass 3 and passes 4 or more combined (P values <0.05). There were no significant differences between thrombus fragments retrieved in pass 1 and pass 2 in terms of RBC, WBC, fibrin, and platelet composition (P values >0.05). Similarly, when each composition of thrombus fragments retrieved in pass 3 and passes 4 or more combined were compared with each other, no significant difference was noted (P values >0.05).Our findings confirm that thrombus fragments retrieved with each pass differed significantly in histological content. Fragments in the first passes were associated with lower fibrin and platelet composition compared to fragments retrieved in passes three and four or higher. Also, thrombus fragments retrieved after failed pass were associated with higher fibrin and platelet components.
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Thrombus formation is closely related to hydrodynamical conditions. Fresh human blood in healthy donors was used for the experiments. The blood flow in Chandler's ring showed it is a three\|dimensional flow and of secondary conditions. The shear stress on the wall is the maximum. Both curvature of thrombus and blood reflux should be considered for extracorporeal thrombus formation. Results also showed that the cause of thrombus formed in lower menisucs may be the following one: The fluid element at relatively high speed strikes on lower meniscus, which leads to gathering of platelet and red blood cells. When the rotating time of thrombus ring was less than 10min, thrombus did not form well. 15min was the best time for thrombus formation. At rotating speed of 3\^75rpm, thrombus can't come in form.
Extracorporeal
Extracorporeal circulation
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Objective:To study the effect of the blood flow patterns change on thrombus formation; and to study the impact of presence of thrombus on the vascular wall pressure and the wall shear stress. Methods: Computational fluid dynamics(CFD) software was used to establish simplified 2D vessel models, and the two-phase flow of blood and thrombus was simulated to study the rules of the thrombus flow as well as the influence of the size, and the influencethe blocking rate and different forms of thrombus on the vascular wall. Furthermore, the regions prone to thrombus formation were analyzed and predicted. Results: Research showed that the flow pattern of different presence forms and sizes of thrombus varied, and it was related to blood flow rate. Conclusion: Presence of thrombus can lead to pressure change and increased wall shear stress, causing damage to the vascular intimal. Thrombus in the low-speed regions near the site of the blockage are likely to form and the risk of thrombus formation is higher with the increasing of occlusion rate.
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Pannus
Presentation (obstetrics)
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Arterial thrombosis plays a critical role in acute coronary syndromes and stroke. Therefore, the ability to detect thrombus in vivo has a significant clinical implication. Magnetic resonance imaging (MRI) has shown promise in noninvasive thrombus detection. However, thrombus characterization and age definition remain difficult. We sought to evaluate the use of a fibrin-targeted peptide (EP-2104R) for MR thrombus detection and to compare this modality with non-contrast-enhanced (NCE) MRI and with Gd-DTPA injection at various ages and time points after thrombus generation.Carotid artery thrombosis was induced by external injury and stasis in 18 rabbits. T1-weighted MRI was performed before and after contrast agent injection, within 6 hours of thrombus induction, at 48 hours, at 1 week, and every week up to 8 weeks after injury. Correlation with histopathology was performed. The fibrin-targeted contrast agent accurately detected all thrombi, regardless of their size, location, and age. Although thrombus signal intensity after injection decreased with thrombus age (P<0.001), enhancement at 8 weeks was still present. Gd-DTPA injection was not associated with an improvement of thrombus detection. EP-2104R was superior to both NCE and Gd-DTPA injection (P<0.001). Histopathologic examination showed thrombus organization over time. Fibrin was gradually replaced by fibrous tissue. A strong correlation was found between thrombus enhancement and collagen content of the organizing thrombus with time (R=-0.89; P<0.001).In an experimental animal model of carotid thrombosis, we have demonstrated the superiority of a fibrin-targeted MR contrast agent for in vivo detection of chronic or organized thrombus, compared with NCE MRI and Gd-DTPA injection.
Histopathology
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Objective To observe the accuracy of 99 Tcm macroaggregated albumin(99 Tcm-MAA)scintigraphy of venous thrombus in rabbit models.Methods Twenty New Zealand rabbits were divided into thrombus group(n=15)and control group(n=5).Inferior vena cava(IVC)thrombus models were established in thrombus group with open surgical operation,while sham operation was performed in control group.Images were obtained after 99 Tcm-MAA injection via the right low extremity vein.The ratio of thrombus to background in the thrombus group was calculated,while in control group the ratio of corresponding area of thrombus to background was calculated.Paraffin slices of thrombus were stained with Hematoxylin-eosin(HE).Results IVC thrombus models were successfully established in 13rabbits of thrombus group.99 TcmMAA uptake in thrombi were clearly visualized in 8rabbits,while negative results were obtained in 5rabbit models in thrombus group.All rabbits of control group also showed negative images.The thrombus to background ratio(4.06±0.49)in thrombus group were higher than the corresponding area of the thrombus to background ratio(2.27±0.24)in control group(t=5.629,P0.05).All IVC thrombi of thrombus group were confirmed fresh mixed thrombi by Hematoxylin-eosin stains.Conclusion The venous thrombus could be imaged by 99 Tcm-MAA scintigraphy in rabbit IVC thrombus models,but the accuracy was relatively low.
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Hyperbaric oxygen (HBO₂) therapy has a long history of use. However, its effect on thrombus formation is unclear. Many reports have indicated that it accelerates platelet aggregation, which suggests that it may increase thrombotic events. However, clinical trial results are inconsistent, and no previous reports have demonstrated that HBO₂therapy does in fact increase thrombotic events. Here, we used a total thrombus formation analysis system (T-TAS) to analyze changes in thrombus formation in a specimen group exposed to constant hyperbaric pressure in vitro, and a control group.Blood samples were collected from two sets of 10 healthy volunteers (mean age, 28.8 years) with no underlying disease. In the pressurized group, a constant pressure was applied to specimens in temperature-controlled test tubes; the non-pressurized group served as the control. Thrombus formation in samples from both the pressurized and control groups were measured using the T-TAS immediately, 20 minutes, and 40 minutes after pressurization.In the pressurized group, the onset of thrombus formation was significantly delayed, confirming a reduction in thrombus formation ability. However, the reduced ability for thrombus formation in the pressurized group recovered to the level of the control group. That is, the change in thrombus formation ability caused by pressure was proven to be reversible.We are the first to ascertain a decrease in the thrombus formation ability in specimens exposed to hyperbaric pressure using a T-TAS, which is capable of measuring thrombus formation in an environment similar to that in vivo.
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