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The thrombus seemed to resolve with the help of oral coumadin.
Further echocardiography 8 months later suggested that the thrombus had resolved.
In the other four patients with no symptoms of ischemia, the therapy was undertaken when thrombus was detected in a coronary aneurysm.
When no change in the state of the thrombus was detected after continuous intravenous infusion of urokinase for 10 days, the treatment was discontinued.
The duration of intravenous infusion of urokinase was determined by the disappearance of thrombus as judged by echocardiography.
The only means of detecting the earliest appearance of a thrombus in aneurysms, therefore, is intensive echocardiographic observation of the large aneurysms.
In the remaining six patients, cross-sectional echo did not demonstrate any formation of thrombus.
At autopsy, fibrous obstruction was noted proximal to the stent, and thrombus within the stent.
Although no intracardiac thrombus was detected, the stroke and the arterial embolization were considered to be of cardiac origin.
Despite these difficulties, two independent observers agreed on the diagnosis of intraatrial thrombus in eight of 26 patients.
It should be performed early after diagnosis since organization of thrombus may obscure the results.
The cardiac repair was sound but there was partly organized thrombus adherent to the tricuspid valve and ventricular septum patch.
Two years later in the same case, the thrombus seemed more tight.
Postoperative echocardiography did not identify any right-to-left shunting, nor was intra-atrial thrombus seen.
Six of these nine patients had evidence of atrial thrombus.
