Free-floating Thrombus Research Articles

Transesophageal echocardiographic diagnosis of a free-floating atrial thrombus

WO-DIMENSIONAL (2D) transesophageal echocardiography (TEE) has gained increasing popularity as an intraoperative monitor of left ventricular and valvular function during cardiac surgery.‘m5 This technique is the most sensitive and specific method for detecting left atria1 thrombi.6%7 Complications of such thrombi include peripheral embolization causing cerebrovascular accidents and obstruction of either the mitral or aortic valve orifice resulting in sudden death.H-‘5 Intraoperative TEE used during coronary artery bypass surgery (CABG) detected a free-floating left atria1 thrombus prior to weaning from cardiopulmonary bypass (CPB), permitting emergent thrombectomy in this patient. This discovery may have prevented subsequent valvular obstruction, sudden death, or peripheral embolization. The thrombus was not observed on either a preoperative transthoractic echocardiogram or prebypass TEE examination. The case demonstrates that TEE is useful in monitoring changes in ventricular wall motion, as well as detecting structural and intracavity abnormalities.

Free-floating but immobile ball thrombus in left atrium: diagnosis aided by transoesophageal echocardiography

A patient in whom a free-floating but immobile ball thrombus developed in the left atrium in association with mitral stenosis is reported. Certain unusual echocardiographic findings are described.

A case of free-floating left atrial ball thrombus in mitral stenosis

A free-floating ball thrombus in the left atrium is a rare complication of the mitral valvular disease. A 53-year-old man was admitted for pain and paresthesia on both legs. On admission he had auscultatory sign of mitral stenosis and mitral regurgitation, and the roentgenogram of his chest revealed a slight pulmonary venous congestion, enlargement of the pulmonary conus and cardiomegaly. Laboratory findings including complete blood counts, coagulation studies and blood chemistry were normal. An echocardiographic examination revealed a mitral stenosis and a free-floating ball thrombus in the left atrium. We performed the emergent open heart surgery for removal of the ball thrombus and mitral replacement successfully with Duromedics 29 mm valve. The size of thrombus was mm.

Left atrial free-floating thrombus with multiple systemic emboli in orthotopic heart transplantation

Auoroscopy-guided biopsy of the mass of the right atrium.” However, two-dimensional echocardiography may fail to reveal an intracardiac mass, as in the present case. Therefore a high level of suspicion is necessary to make a correct diagnosis of the disease. The treatment of primary malignant lymphoma of the right atrium has not yet been established. There is no evidence that chemotherapy prolongs survival in patients with this disease. Bear and Moodie, however, have reported on a patient who was successfully treated with radiation. In addition, either surgical tumor resection or heart transplantation has been suggested as treatment for patients with primary cardiac tumors.4 In view of the extremely poor prognosis of patients with primary malignant lymphoma of the right atrium, we suggest that such patients be treated, if at all, with an aggressive surgical procedure. Neoplastic embolisms, as suggested by our case, do not respond to medical treatment. Therefore a surgical procedure to remove emboli, if possible, is mandatory to save life. Since extranodal lymphoma is common in immunocompromised patients,3 it is reasonable to assume that the prevalence of primary lymphoma of the right atrium will increase with time. Inasmuch as massive pulmonary neoplastic embolism may develop in such patients, physicians should be on the alert for this diagnosis.

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

Free-floating ball thrombus in left atrium: pathological features and clinical implications

A patient with a free-floating ball thrombus in the left atrium complicating mitral stenosis is described. The pathological features and clinical implications are discussed.

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

Free-floating ball thrombus in left atrium after mitral valve replacement: Surgical removal following embolization to the aorta

Free-floating ball thrombus in left atrium after mitral valve replacement: Surgical removal following embolization to the aorta

Free-floating Thrombus of the Extracranial Internal Carotid Artery

Free-floating clots of the extracranial internal carotid artery are generally considered as surgical emergencies. This retrospective study analyzes six free-floating clots diagnosed by arteriography. Three of these patients had a fixed stroke while the other three had an evolving stroke. Three patients had antecedent ocular or hemispheric transient ischemic attacks. The causes of free-floating clots in the internal carotid artery were atheromatous stenosis in two cases, ulcerated plaque in three cases, and carotid artery dissection in one. All six patients were seen late, approximately 15 hours after their neurologic accident. They were treated with intravenous heparin over a two to five week period. Repeat arteriograms demonstrated complete clot lysis in four instances, while partial lysis was seen in one case. Moderate extension of thrombus occurred in one case only. No further neurologic complications were noted during the treatment by heparin. As indicated by follow-up arteriographic findings, secondary surgery was performed for major carotid lesions and residual clots in five cases. The free-floating thrombus syndrome of the carotid artery should not be considered as a surgical emergency when discovered late in the wake of an acute neurologic accident.

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.

Clinical significance of free-floating venous thrombi

To evaluate the fate of free-floating venous thrombi, venous duplex scans of 5238 consecutive lower extremities over a 212 year period were reviewed. Acute deep venous thrombosis was found in 732 cases. Eighty-two free-floating deep venous thrombi were diagnosed in 73 of these patients. Nine of 72 patients (13%) had pulmonary emboli as diagnosed by ventilation perfusion scanning or pulmonary angiography or both. Seven of these patients (78%) had a pulmonary embolus before the initial duplex scan. Two (22%) had a pulmonary embolus after the diagnosis of free-floating thrombus. Thirty-three of 73 patients (45%) had follow-up of free-floating thrombi by duplex scanning performed in the acute period (less than 30 days): 18 (55%) showed attachment of the free-floating thrombus, three (9%) showed progression in size of the free-floating tail, and eight (24%) showed decrease in size or resolution of the free-floating thrombus. Four (12%) showed persistent thrombus without evidence of resolution, propagation, or attachment. In conclusion, free-floating venous thrombi occurred in 10% of cases of acute deep venous thrombosis. Only 13% of free-floating thrombi were associated with clinically significant pulmonary emboli, confirmed by ventilation perfusion scanning. Usually the embolus occurred before diagnosis of free-floating thrombus. Most free-floating thrombi followed noninvasively by duplex scanning do not embolize, but rather they become attached to the vein wall or resolve.

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.

Recurrent Pulmonary Embolism: A Prospective Study

We have prospectively studied a series of 121 consecutive patients with venous thromboembolism (38 with pulmonary embolism, 83 with venous thrombosis of the lower extremities) searching for recurrences of pulmonary embolism despite adequate heparin therapy. A baseline ventilation-perfusion lung scan was obtained initially in every patient, whether the original diagnosis was pulmonary embolism or venous thrombosis. Repeat chest roentgenograms and lung scans were obtained routinely at eight days of heparin treatment. The primary trial endpoints were a finding of a clinically apparent recurrent pulmonary embolism, or laboratory evidence of subclinical pulmonary embolism. Eight items of clinical and laboratory information were recorded at admission and then correlated with the lung scan results. Recurrences were seen in seven of 38 patients with an original diagnosis of pulmonary embolism, and in five of 83 patients admitted because of venous thrombosis (p = 0.034). Recurrences were also more frequent in patients with a free-floating thrombus on venography (p = 0.014). The risk of new defects in patients with venous thrombosis and without free-floating thrombus was 3.05 percent, venous thrombosis with free-floating thrombus, 13.33 percent; patients with pulmonary embolism without free-floating thrombus, 11.42 percent; and with free-floating thrombus, 38.67 percent. Venography seems thus mandatory in patients with pulmonary embolism, as it recognizes a subgroup of patients at a high risk of recurrences.

Free-floating iliofemoral thrombus. A risk of pulmonary embolism.

We retrospectively evaluated the risk of pulmonary embolism in hospitalized patients with venographically proved iliofemoral deep vein thrombosis (DVT). Venograms and clinical records of 78 patients with iliofemoral DVT were reviewed and the proximal intraluminal thrombus was characterized as free-floating (greater than 5-cm nonadherent segment) or occlusive (no free-floating elements). The incidence of pulmonary embolism confirmed by high-probability radioisotope ventilation-perfusion lung scanning within ten days following venography was 9% (7/78) and was associated with 60% (3/5) free-floating and 5.5% (4/73) occlusive phlebographic criteria (P less than .05). All patients who experienced pulmonary embolism were given therapeutic heparin treatment (partial thromboplastin time, more than twice the control value). The mean (+/- SD) time from the diagnosis of DVT to pulmonary embolism was 104 +/- 60 hours, and 120 +/- 71 hours for patients with free-floating and occlusive thrombi, respectively (P greater than .05). Patients with iliofemoral DVT that met free-floating criteria are at significant risk for pulmonary embolism, despite the administration of heparin.

Free-floating Ball Thrombus in the Left Atrium after Mitral Valve Replacement: Successful Surgical Management

A free-floating ball thrombus in the left atrium is a rare clinical problem with potentially catastrophic consequences. Thus, early diagnosis and prompt surgical intervention are mandatory. Free ball-valve thrombus within the left atrium developed in a patient who had undergone mitral valve replacement with a Starr-Edwards prosthesis seven years previously. The diagnosis was accurately made by two-dimensional echocardiography and was followed by successful removal of a thrombus. A review of the literature is presented.

Free-Floating Left Atrial Thrombus and Systemic Embolization

A patient with mitral stenosis and systemic thromboemboli is presented. Two-dimensional echocardiography demonstrated a spherical thrombus floating freely within the left atrium which was corroborated by postmortem examination. This case is unique in its clinical outcome and provides insight into the pathogenesis of such left atrial thrombi.

Transient (“hole-in-one”) occlusion of the mitral valve orifice by a free-floating left atrial ball thrombus: Identification by two-dimensional echocardiography

Transient (“hole-in-one”) occlusion of the mitral valve orifice by a free-floating left atrial ball thrombus: Identification by two-dimensional echocardiography

Echocardiographic detection of free-floating left atrial thrombus

Echocardiographic detection of free-floating left atrial thrombus