{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:49:23Z","timestamp":1753890563272,"version":"3.41.2"},"reference-count":8,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,3,10]],"date-time":"2021-03-10T00:00:00Z","timestamp":1615334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>Thrombotic angiopathy is a pathologic description to describe endothelial injury, and with sufficient and sustained injury can lead to exposure of underlying tissue factor and the deposition of associated fibrin material. We present briefly a case of an 87-year-old woman with mitral valve regurgitation and atrial fibrillation undergoing mitral valve annuloplasty, Cox-maze procedure, and excision of the left atrial appendage. Pathologic examination of the excised atrial appendage revealed commonly encountered cardiomyocyte hypertrophy and endocardial fibroelastosis, however also showed a non-occlusive, acute thrombotic angiopathy involving epicardial veins. The surgical and immediate post-operative course was unremarkable; however, 3 weeks after discharge, the patient would develop a fatal pulmonary embolism. While fibrin thrombosis developing within the atrial appendage chamber is a recognized concern in the setting of atrial fibrillation, the significance of an acute thrombotic angiopathy involving epicardial veins of the atrial appendage is less clear although in the presented case was the sole potential harbinger of a subsequent fatal thrombotic event.<\/jats:p>","DOI":"10.3389\/fcvm.2021.621632","type":"journal-article","created":{"date-parts":[[2021,3,10]],"date-time":"2021-03-10T04:26:51Z","timestamp":1615350411000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Acute Thrombotic Angiopathy of Atrial Appendage Epicardial Veins: A Seemingly Innocuous Finding Portending a Fatal Outcome"],"prefix":"10.3389","volume":"8","author":[{"given":"Simona","family":"Pichler Sekulic","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miroslav","family":"Sekulic","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,3,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"890","DOI":"10.1097\/PAS.0b013e31827e180b","article-title":"Surgical pathology of atrial appendages removed during the cox-maze procedure: a review of 86 cases (2004 to 2005) with implications for prognosis","volume":"37","author":"Castonguay","year":"2013","journal-title":"Am J Surg Pathol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1368","DOI":"10.1016\/j.amjcard.2015.07.055","article-title":"Prevalence and clinical determinants of left atrial appendage thrombus in patients with atrial fibrillation before pulmonary vein isolation","volume":"116","author":"Nishikii-Tachibana","year":"2015","journal-title":"Am J Cardiol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1916","DOI":"10.1161\/CIR.0b013e318290826d","article-title":"Management of patients with atrial fibrillation (compilation of 2006 ACCF\/AHA\/ESC and 2011 ACCF\/AHA\/HRS recommendations): a report of the American College of Cardiology\/American Heart Association Task Force on practice guidelines","volume":"127","author":"Wann","year":"2013","journal-title":"Circulation"},{"key":"B4","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1053\/j.ajkd.2015.02.340","article-title":"Thrombotic microangiopathy, cancer, and cancer drugs","volume":"66","author":"Izzedine","year":"2015","journal-title":"Am J Kidney Dis."},{"key":"B5","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1016\/0002-8703(87)90719-8","article-title":"Nonbacterial thrombotic endocarditis: a review","volume":"113","author":"Lopez","year":"1987","journal-title":"Am Heart J."},{"key":"B6","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/j.ijcard.2019.09.053","article-title":"Coagulation factors and fibrinolytic activity in the left atrial appendage and other heart chambers in patients with atrial fibrillation: is there a local intracardiac prothrombotic state?","volume":"301","author":"Bartus","year":"2020","journal-title":"Int J Cardiol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"e257","DOI":"10.1161\/CIRCULATIONAHA.106.177292","article-title":"ACC\/AHA\/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society","volume":"114","author":"Fuster","year":"2006","journal-title":"Circulation"},{"key":"B8","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1016\/0002-8703(79)90003-6","article-title":"Thrombosis of epicardial coronary veins in acute myocardial infarction","volume":"97","author":"Hansen","year":"1979","journal-title":"Am Heart J."}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2021.621632\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,10]],"date-time":"2021-03-10T04:26:54Z","timestamp":1615350414000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2021.621632\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,10]]},"references-count":8,"alternative-id":["10.3389\/fcvm.2021.621632"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2021.621632","relation":{},"ISSN":["2297-055X"],"issn-type":[{"type":"electronic","value":"2297-055X"}],"subject":[],"published":{"date-parts":[[2021,3,10]]},"article-number":"621632"}}