Disseminated intravascular and intracardiac thrombosis after
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Massive intracardiac and intravascular thrombosis is a rare complication following cardiopulmonary bypass (CPB). Most of the cases of the disseminated thrombosis have been reported in patients undergoing complex cardiac surgeries and those receiving antifibrinolytic agents during CPB. We report the occurrence of disseminated intravascular and intracardiac thrombosis after CPB in a patient undergoing mitral valve replacement in which no antifibrinolytic agent was used. The possible pathophysiology and management of the patient is discussed.

Case Report
A 35-year-old male presented for emergency MVR for severe mitral stenosis with atrial fibrillation (AF) and acute heart failure. He was receiving erythromycin, digoxin, furosemide, spironolactone, and warfarin therapy. Preoperative transthoracic echocardiography (TTE) showed severely calcific and stenosed MV with an area of 0.9 cm 2 in two-dimensional echocardiography and 0.6 cm 2 using pressure half time, and the peak and mean pressure gradients of 11 and 7 mmHg, respectively. Associated findings included mild mitral regurgitation, presence of left atrial (LA) spontaneous echo contrast, right ventricular systolic pressure of 30 mmHg + right atrial pressure, and an ejection fraction of 60% with no regional wall motion abnormality at rest. The LA diameter was 5.9 cm and the aortic diameter was 3.2 cm. Preoperative laboratory investigations were within normal limits, except elevated serum glutamic-pyruvic transaminase (152 U/L) levels. Preoperative international normalized ratio was 1.5. There was no preexisting history suggestive of deep vein thrombosis and drug allergy. Family history was insignificant for stroke, deep vein thrombosis or pulmonary embolism....