Free-floating left atrial thrombus and systemic embolization

Free-floating giant left atrial ball thrombus with aortic valve disease--a rare entity and a near miss

Large left atrial mural thrombi in the absence of mitral valve stenosis have been reported rarely in the literature. It is even rarer without history of atrial fibrillation (AF). These masses can cause systemic embolization and sudden circulatory collapse when they obstruct the mitral valve. We are presenting a case of giant, free floating ball thrombus, detected after aortic valve replacement for mixed aortic valve disease. It was found immediately before separation from cardiopulmonary bypass by transoesophageal echocardiography and was successfully removed. A ball thrombus without mitral valve disease and AF with aortic valve disease is not yet reported in the literature.

Paroxysmal postural dyspnea related to a left atrial ball thrombus

We report herein an uncommon clinical observation of a 82-year-old woman with paroxysmal postural dyspnea related to a giant ball-thrombus located in the left atrium and partly protruding through the mitral orifice. No mitral stenosis was otherwise disclosed. The patient had a previous medical history of chronic atrial fibrillation without any anticoagulant therapy. The atrial mass was easily removed and the postoperative course was uneventful. Disclosure of such a free-floating ball-thrombus in the left atrial cavity requires prompt surgical treatment because of high risks of acute hemodynamic decompensation due to obstruction of the left ventricular inflow or, more rarely, systemic embolic events.

Embolization of a left atrial ball thrombus during transesophageal echocardiography

We report a case of systemic embolization of a left atrial ball thrombus during transesophageal echocardiography (TEE). A 49-year-old man with rheumatic mitral stenosis and atrial fibrillation underwent TEE to evaluate a transient cerebral ischemic attack. TEE demonstrated a free-floating left atrial thrombus. Disappearance of the thrombus during the study occurred after tachycardia and was associated with acute hemiplegic stroke and an absent radial pulse. The possible mechanism of embolization and the implications for the selection and management of patients undergoing TEE are discussed.