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.
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- Fatal freely mobile left atrial thrombus: fallout of anticoagulation?.J Am Soc Echocardiogr. 2009; 22 (863.e5-6)
- Anterior mitral leaflet and ball valve thrombus: playing hockey in the heart.J Am Coll Cardiol. 2012; 60: e43
Published online: April 03, 2015
Accepted: March 26, 2015
Received in revised form: March 24, 2015
Received: March 12, 2015
© 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.