Free-floating Left Atrial Thrombus Research Articles

Massive free-floating left atrial thrombus

Massive free-floating left atrial thrombus

OP-523 - The Most Desperate Moment: Disappeared Free-Floating Left Atrial Thrombus

Abstract: Left atrial thrombus is a rare complication that may develop especially on the basis of atrial fibrillation and mitral valve disease. Especially free-floating thrombus in left atrium may cause several serious complications due to high risk of systemic embolization. An 85-year-old woman patient came to hospital with nausea and vomiting complaints. The transthoracic echocardiography showed a free-floating thrombus-like appearance in the left atrium and after a short time, the thrombus disappeared.

Syncope Due to a Free-floating Left Atrial Thrombus.

Syncope Due to a Free-floating Left Atrial Thrombus.

Free Floating Left Atrial Thrombus Disappearing during Echocardiography

An 82-year-old woman with a history of previous cerebral infarction and atrial fibrillation was hospitalized with aphagia. Brain magnetic resonance imaging showed a dot-like high signal intensity in the left occipital subcortex. With a working diagnosis of acute cerebral infarction due to cardiac emboli, trans-thoracic echocardiography (TTE) was performed. The TTE showed an oval shaped, mobile thrombus, approximately 1.9 × 1.5 cm in size within the left atrial appendage. For further evaluation of mobile thrombus in the left atrial appendage, a trans-esophageal echocardiography (TEE) was done. The TEE showed an oval shaped, mobile thrombus in the left atrial appendage (Fig. 1A). Subsequently, during follow-up TTE, the thrombus was found to be freely floating in the left atrial cavity during each cardiac cycle (Fig. 1B-F and Supplementary movie 1). After a number of cardiac cycles, the thrombus suddenly disappeared in TTE. The patient's overall clinical condition and neurologic examination continued to appear stable for the entirety of echocardiographic examination. Fig. 1 Trans-esophageal echocardiography showed a free floating thrombus in the left atrial appendage (A). Trans-thoracic echocardiography (TTE) showed free floating thrombus in the left atrial appendage (B). TTE showed the thrombus moving from left atrial appendage ... After one day, the patient complained claudication in the lower right limb. In physical examination, the patient's femoral pulses were not present to prompt a pulse exam. We performed a 3-dimensional (3D) femoral computer tomography (CT) to evaluate for occlusion. The 3D femoral CT showed a new filling defect in the right femoral artery in comparison with an abdominal enhanced CT performed for evaluation of fever 2 days ago (Fig. 2). Following the examination, the patient was placed on warfarin for anticoagulation therapy. The patient was discharged from the hospital with an uneventful recovery and has been doing well without additional embolic events after discharge and maintenance anticoagulation therapy. Fig. 2 Abdominal enhanced computer tomography (CT) for evaluation of fever did not show a filling defect in the right femoral artery in axial plane 2 days ago (A and C). 3-dimensional (3D) femoral CT showed a filling defect (arrow) in the right femoral artery ... Left atrial free floating thrombus is infrequent but predominantly associated with mitral valve disease, atrial fibrillation, as in our case, and hypertrophic cardiomyopathy.1-4) The presence of left atrial free floating thrombus is linked to higher embolic rates and the most common presentation of left atrial thrombus is, as in our case, peripheral embolization.5) This case is an interesting case of free-floating left atrial thrombus disappearing during echocardiography.

Large free-floating left atrial thrombus with normal mitral valve

Left atrial thrombus in the presence of diseased mitral valve and atrial fibrillation is a well known entity. But it is very rare to occur in the presence of normal mitral valve apparatus. We report the case of a 36 year old female who presented with left atrial ball valve thrombus and normal mitral valve apparatus and underwent surgery. This patient with gangrene of right lower limb came for cardiac evaluation. She had infarct in left middle cerebral artery territory- ten months prior to this admission and was on treatment for infertility. She had atrial fibrillation. Emergency surgery to remove the thrombus should be considered given its potential life threatening embolic nature.

Uneventful Disappearance of a Large Left Atrial Ball Thrombus with Enoxaparin in a Patient with Mitral Stenosis Associated with Pregnancy

An atrial thrombus is a relatively common echocardiographic finding in patients with mitral valve stenosis (MVS) and atrial fibrillation (AF). However, a “ball thrombus” or floating thrombus in the left atrium is a rare and specific entity associated with MVS. A 24-year-old woman with rheumatic MVS presented with complaints of progressive dyspnea and inferior limbs edema that began 23 days earlier after a caesarean operation for stillbirth carried out at 8 months of pregnancy. At the time of hospitalization, she was in New York Heart Association functional class III and the ECG showed sinus rhythm. Transthoracic color-flow Doppler echocardiography revealed a thick, stenotic mitral valve with a valvular area of 0.9 cm2, and an echogenic large left-atrial mass diagnosed as a free-floating left-atrial thrombus that was corroborated by transesophageal echocardiography. She refused surgery and was treated medically, and low molecular weight heparin (LMWH) (enoxaparin 80 mg/12 h) was given for 14 days and was discharged uneventfully on coumarin. Two days before discharge, a transthoracic and transesophageal ecocardiography showed disappearance of the ball thrombus uneventfully leaving spontaneous echo contrast inside the left atrium. To the best of our knowledge, this is the first case showing disappearance of a giant left atrial ball thrombus with LMWH treatment in a patient with severe MVS during sinus rhythm associated with pregnancy.

A free-floating left atrial thrombus develops intermittent entrapment in the mid-ventricle during diastole

Free-floating left atrial thrombi are rare. Here we report a case of a 75-year-old woman with atrial fibrillation who was admitted for treatment of acute myocardial infarction. A free-floating left atrial thrombus was found incidentally on echocardiography. Ten days after percutaneous coronary intervention, the patient had mild faintness with transient hypotension, and it was found that the left atrial thrombus had developed intermittent entrapment in the mid-ventricle during diastole, with abrupt rebound back to the left atrial cavity during systole. Urgent removal of the thrombus was performed successfully. Although the free-floating thrombus had appeared to be spherical, like a ball thrombus, on echocardiography, the excised thrombus was pedunculated. A cut section revealed a laminated thrombus with an onion-skin-like appearance.

A free-floating left atrial thrombus visualized by real-time three-dimensional echocardiography

Left atrial free-floating thrombus is a rare disorder, which has a high embolic potential and may also cause sudden death because of the occlusion of the mitral orifice. In the evaluation of intracardiac masses, real-time three-dimensional echocardiography (RT3DE) appears to be a new promising technique, which acquires a definite information …

Syncope induced by transient total occlusion of the mitral valve orifice by a giant free-floating left atrial thrombus

Left atrial ball thrombus is a rare disorder with potential fatal systemic embolism or mitral valve orifice occlusion that may result in sudden death. Its treatment is still controversial and is often associated with poor prognosis. We report the case of a 95-year-old woman with a history of permanent atrial fibrillation who was admitted to our hospital for syncope. A two-dimensional echocardiogram showed an enormous left atrial thrombus protruding through the mitral valve orifice. Cardiac surgeons declined to operate on the patient because of her very advanced age. Therefore, she was put on heparin but unfortunately died on day 17, secondary to a sudden cardiovascular arrest.

Free-floating left atrial thrombus complicating mitral stenosis

Free-floating thrombus is a rare disorder that usually occurs in the setting of a dilated left atrium. It is an important condition because it can produce sudden death by obstructing the mitral orifice or cause embolic events. Early diagnosis and surgical treatment are mandatory.

Fatal Free-Floating Left Atrial Thrombus

This 68-year-old woman was resuscitated after cardiac arrest. Echocardiography showed a dilated left atrium and severe mitral-valve stenosis. A free-floating thrombus caused intermittent occlusion of the mitral valve.

Role of mitral regurgitation in preventing mitral orifice occlusion in a patient with a free-floating left atrial thrombus and mitral stenosis

Role of mitral regurgitation in preventing mitral orifice occlusion in a patient with a free-floating left atrial thrombus and mitral stenosis

Free-floating left atrial thrombus: Medical management directed by transesophageal echocardiography

Free-floating left atrial thrombus: Medical management directed by transesophageal echocardiography

Free-Floating Left Atrial Thrombus with Recurrent cerebral Embolic Event Associated Mitral Stenosis

Free-Floating Left Atrial Thrombus with Recurrent cerebral Embolic Event Associated Mitral Stenosis

Free-Floating Left Atrial Thrombus: Echocardiographie Demonstration and Treatment with Oral Anticoagulation

Echocardiography showed a voluminous free-floating left atrial thrombus in an 80-year-old woman affected by rheumatic mitral stenosis with long-standing atrial fibrillation who was admitted because of transient left arm paralysis and drop attack without loss of conscience. She refused open heart surgery and was treated with warfarin. One month later echocardiography detected complete disappearance of the thrombus; no episodes of peripheral embolization had occurred since the beginning of medication with warfarin. According to this report, warfarin is a valuable alternative to surgical treatment for freefloating left atrial thrombi.

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.

Free-floating left atrial thrombus and its mechanical interaction with mitral regurgitant jet assessed by color Doppler echocardiography

Free-floating left atrial thrombus and its mechanical interaction with mitral regurgitant jet assessed by color Doppler echocardiography

Mitral stenosis and free-floating left atrial thrombus: Demonstration of the “hole-in-one” effect by color Doppler echocardiography

Mitral stenosis and free-floating left atrial thrombus: Demonstration of the “hole-in-one” effect by color Doppler echocardiography

Unusual thrombi in the setting of rheumatic heart disease

We report two patients with unusual intracavitary thrombi in association with rheumatic mitral stenosis. One patient had a large free-floating left atrial thrombus immediately after successful closed mitral valvotomy causing recurrent acute pulmonary oedema in the post-operative phase. The other patient was detected to have multiple, discrete and calcified left ventricular thrombi in the presence of severe left ventricular systolic dysfunction. The diagnosis in both cases was made by cross-sectional echocardiography.

Doppler and echocardiographic diagnosis of a free-floating left atrial thrombus

We report a case of a free-floating left atrial thrombus in a patient with severe mitral stenosis diagnosed by cross-sectional echocardiography. The Doppler technique was very useful in explaining some peculiar auscultatory and clinical aspects present in this rare complication of mitral valvar stenosis.