Rheumatic heart disease contributes to significant cardiovascular morbidity and mortality and remains a predominant cause of cardiac morbidity in developing nations. Coronary angiography is indicated as a routine procedure in the preoperative assessment of patients with valvular heart disease, who are older than 40 years age. Though transthoracic echocardiography (TTE) is routinely done preoperative in every patient, transesophageal echocardiography (TEE) is an important imaging modality especially for the identification of thrombus. The diagnosis of associated left atrial thrombus changes the approach to the surgery, regardless of the symptoms. Rheumatic mitral valve disease contributes to significant cardiovascular morbidity and mortality worldwide. It is the predominant cause of cardiac morbidity in developing nations. This case demonstrates incidental finding of large left atrial thrombus, diagnosed incidentally through transesophageal echocardiography in a patient who was previously diagnosed as a case of severe mitral stenosis with coronary artery disease.
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