Heart, Lung and Circulation
Image| Volume 24, ISSUE 8, e139-e140, August 2015

Supermoon-like Thrombus at the Mitral Valve: Struggle between the Bad and the Worse

Published:April 03, 2015DOI:
      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 thumbnail gr1
      Figure 1Cerebral angiography showing acute cerebral infarction due to occlusion of the proximal posterior cerebral artery.
      Figure thumbnail gr2
      Figure 2Two-dimensional (A, B) and Doppler echocardiography (C) showing moderate mitral stenosis and a large ball-valve thrombus in the left atrium.
      Figure thumbnail gr3
      Figure 3Surgical removal of a large 4.3 × 2.8 cm round free-floating thrombus from the left atrium.


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