Cor Vasa 2024, 66(4):444-447 | DOI: 10.33678/cor.2024.039

Bilateral Acute Limb Ischemia due to Severe Rheumatic Mitral Stenosis and Atrial Fibrillation with Neglected International Normalized Ratio Control

Muhammad Aditya^{a, b}, Tita Rif'atul Mahmudah^{a, b}, I Gde Rurus Suryawan^{a, b}

^a Department of Cardiology and Vascular Medicine, Soetomo General Hospital, Surabaya, Indonesia

^b Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia

Acute limb ischemia (ALI) poses a critical threat to limb viability, necessitating urgent revascularization interventions. This case report discusses a 47-year-old Asian woman with bilateral ALI due to severe rheumatic mitral stenosis (MS) and atrial fibrillation (AF), with neglected international normalized ratio (INR) control. The patient presented with sudden bilateral leg pain at rest, accompanied by bluish discoloration and sensory loss. Echocardiographic findings indicated severe rheumatic MS along with a thrombus in the left atrial appendage. The computed tomography angiogram revealed a near-total thrombus originating from the upper abdominal aorta. Immediate bilateral thromboembolectomy was performed. Subsequent improvements were observed, and the patient was eventually discharged in stable condition. Proper anticoagulant therapy, vigilant INR monitoring, and a strategic approach to valve replacement are crucial for optimizing outcomes in cases of ALI involving concurrent MS and AF.

Keywords: Acute limb ischemia, Atrial fibrillation, International normalized ratio, Rheumatic mitral stenosis

Received: August 15, 2023; Revised: January 14, 2024; Accepted: May 8, 2024; Prepublished online: June 2, 2012; Published: September 9, 2024  Show citation