A 68-year-old woman presented with a 6-week history of shortness of breath on exertion. She had longstanding mitral stenosis and atrial fibrillation and was not taking oral anticoagulants.Thirty years previously, she reportedly had had a stroke and made a full recovery. Transthoracic echocardiography ( Figure 1) demonstrated a freely mobile mass in the left atrium associated with severe mitral stenosis and mild aortic stenosis. The mass bounced around the atrium like a ball in a pinball machine.At surgery, a large, unattached, completely smooth, circular thrombus (Figures 2 and 3) was removed, and the patient had a mitral valve replacement and aortic valvotomy.
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