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

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 fi brillation (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 fi ndings 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.