Disseminated intravascular and intracardiac thrombosis after
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Massive intravascular and intracardiac thrombosis after separation from cardiopulmonary bypass (CPB) is a very rare, but dreaded complication.Preexisting thromboembolic diseases or acquired coagulation disorders (related to antifibrinolytic therapy) have been associated with this unusual life-threatening complication.

We report the occurrence of severe acute massive intracardiac and intravascular thrombosis during the immediate post-CPB period in a patient who underwent emergency mitral valve replacement (MVR).

Case Repor
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....