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Corresponding author at: Director of Echocardiography Laboratory, The Heart Center of Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 501-757, South Korea Tel.: +82-62-220-6977; fax: +82-62-223-3105
An 81 year-old woman was referred to the echocardiography laboratory for evaluation
of the cardioembolic source of cerebral infarction. Earlier, the patient was diagnosed
with acute cerebral infarction due to occlusion of the proximal posterior cerebral
artery (Figure 1), which was successfully treated with mechanical thrombectomy. Echocardiography revealed
moderate mitral stenosis (MS) with a mitral valve area of 1.23 cm2 and a large ball-valve thrombus, which was freely floating within the enlarged left
atrium. As blood flowed from the left atrium to the ventricle, this supermoon-like
thrombus tried to pass through the mitral valve but failed repeatedly because of MS
(Figure 2, Movie I-III in the online-only data supplement). Considering the risk of fatal embolisation,
the thrombus was surgically removed and mitral valvuloplasty was performed. A large
4.3 x 2.8 cm round free-floating mass was removed from the left atrium (Figure 3). Histopathological examination showed the mass to be an organised thrombus.
Figure 1Cerebral angiography showing acute cerebral infarction due to occlusion of the proximal
posterior cerebral artery.
