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

Nurra, V.; Calisi, Pasqualina; Astengo, Davide; Ballerini, R.; Oliveri, María Beatriz; Torriglia, A.; Torrielli, A

doi:10.1159/000470158

Cited by 6 publications

(5 citation statements)

References 4 publications

(5 reference statements)

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“…In all of these cases, thrombi had resolved within 1 month of initiation of anticoagulation. 3 This case illustrates the rare phenomenon of FLABT. This is one of the first reported FLABT following MVR in which medical management was chosen, and perhaps the first without resolution of the thrombus in the first month following initiation of therapy.…”

Section: Discussionmentioning

confidence: 80%

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Free‐Floating Left Atrial Ball Thrombus Following Mitral Valve Replacement

et al. 2005

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We report the case of a 51-year-old woman who underwent mitral valve replacement for prolapse with severe regurgitation, depressed ejection fraction, and atrial fibrillation. Two weeks post-operatively, a transesophageal echocardiogram was performed for bacteremia. The patient was found incidentally to have a large free-floating ball thrombus in the left atrium. The patient was managed with anticoagulation because of the high-risk nature of repeat surgery. One month following diagnosis, the patient still had persistent thrombus in the left atrium seen on transthoracic echocardiography despite therapeutic anticoagulation. Free-floating ball thrombus is a rare and dramatic finding seen on echocardiography in patients with mitral valve disease.

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Section: Discussionmentioning

confidence: 80%

“…Several other authors have reported successful medical therapy in patients with rheumatic mitral stenosis and FLABT. In all of these cases, thrombi had resolved within 1 month of initiation of anticoagulation 3–6 …”

Section: Discussionmentioning

confidence: 98%

Free‐Floating Left Atrial Ball Thrombus Following Mitral Valve Replacement

et al. 2005

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“…However, we decided not to start fibrinolysis because of: (i) lack of available evidence in the setting of LABT; (i) the high risk of catastrophic cerebral and systemic arterial embolization due to the fragmentation of such a large thrombus. Although one successful case with anticoagulation therapy alone has been described, 11 it accounts for small size mass, while most successful cases were treated surgically. The outcome of untreated ball thrombus is unlikely to be favourable.…”

Section: Discussionmentioning

confidence: 99%

A giant and double-walled left atrial ball thrombus complicating a mitral stenosis: case report—a truck tire into the heart

Selimi

Ianni²,

Molisana³

et al. 2022

European Heart Journal - Case Reports

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Background High thromboembolic risk associated with rheumatic mitral stenosis has been well established, especially in concomitant atrial fibrillation, however the presence of left atrium ball thrombus is an uncommon finding. Case Summary a 75-year-old woman with a history of mild rheumatic mitral stenosis was admitted to Emergency Department with cardiogenic shock and high ventricular rate atrial fibrillation. Emergency electrical cardioversion was performed - before trans-oesophageal echocardiography (TOE) – due to hemodynamic deterioration which restored sinus rhythm. Transthoracic echocardiography (TTE)revealed severe reduction of left ventricular ejection fraction (LVEF: 15%), severe rheumatic mitral stenosis and a large, perfectly rounded mass, situated at the ostium of left upper pulmonary vein. Due to the persistence of hemodynamic instability and acute pulmonary oedema the patient was intubated and mechanically ventilated and treated with intravenous administration of inotropes and high doses of diuretics. During the stay in Intensive Care Unit a TOE confirmed a spherical and double walled mass suggesting a working diagnosis of left atrial ball thrombus (LABT). The case was discussed in Heart Team and considering the poor hemodynamic status in the contest of refractory cardiogenic shock with evidence of multi-organ failure, emergency surgical thrombectomy and mitral valve replacement was deemed prohibitive. Patient developed cardiac arrest and emergency TTE showed left atrial mass engaged into the mitral valve totally obstructing the left ventricle inflow tract. The autopsy and histologic examination confirmed the thrombotic nature of the mass. Discussion a free-floating ball thrombus in the left atrium is an unusual occurrence in rheumatic mitral stenosis and it may cause fatal systemic embolization or acute left ventricular inflow obstruction, resulting in syncope, pulmonary congestion and sudden cardiac death. When possible, emergency surgical thrombectomy and mitral valve replacement can be life-saving.

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“…[12][13][14] Treatment for a ball thrombus is necessary to prevent complications arising from the unstable nature of such masses, which may fragment and produce peripheral embolization or total occulusion of the mitral valve orifice resulting in sudden death. 15 Once the diagnosis of a free-floating ball thrombus is established, prompt surgical intervention is recommended. 1,2 Anticoagulation and thrombolytic therapy are not part of the acute management of left atrial ball thrombus, but the importance of anticoagulation in preventing recurrence is obvious.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Anticoagulation and thrombolytic therapy are not part of the acute management of left atrial ball thrombus, but the importance of anticoagulation in preventing recurrence is obvious. Although one successful case with anticoagulation therapy alone has been reported, 15,16 most successful cases were treated surgically. Anticoagulation therapy should be considered as a treatment for freefloating ball thrombus only in extremely high-risk cases that have various complications or for patients refusing surgery.…”

Section: Discussionmentioning

confidence: 99%

Two Cases of a Free-Floating Ball Thrombus in the Left Atrium.

Kaneda

Michihata

et al. 2002

Circ J

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free-floating thrombus in the left atrium without attachment to either the atrial wall or the mitral leaflet is an extremely rare clinical manifestation with potentially catastrophic consequences. 1 Its symptomatic presentation is variable. Fragmentation of the thrombus followed by peripheral embolization will produce ischemia or infarction in the myocardium, brain, viscera, or extremities. Partial or total occlusion of the mitral valve orifice may cause syncope and/or pulmonary congestion. 2 We present 2 cases of free-floating ball thrombus in the left atrium. Case Reports Case 1A 59-year-old female complaining of severe dyspnea at rest was admitted to hospital. Three years earlier, the patient was diagnosed with mitral stenosis and chronic atrial fibrillation. Auscultatory findings were typical for mitral stenosis. Transthoracic echocardiography showed a 2.5×2.5 cm free-floating ball thrombus in the left atrium and severe, calcified mitral stenosis (mitral valve area = 1.5 cm 2 , calculated by pressure half-time method) and preserved ventricular function ( Fig 1A). The thrombus rolled and tumbled in the left atrium, bounced off the atrial walls, and rotated. Emergency thrombectomy and mitral valve Circulation Journal Vol.66, September 2002 replacement (St Jude Medical (SJM) 29M) were performed successfully and her postoperative course was uneventful.The thrombus was round, smooth, nonpedunculated and 3 cm in diameter (Fig 1B) A free-floating ball thrombus in the left atrium is an unusual occurrence that may cause fatal systemic emboli or left ventricular inflow obstruction, often resulting in sudden death. The first of 2 cases was a 59-year-old female with mitral stenosis and chronic atrial fibrillation who presented with severe dyspnea. Transthoracic echocardiography revealed a free-floating ball thrombus and emergency thrombectomy and mitral valve replacement were performed successfully. A second thrombus, which was not found at preoperative examination, was attached to the anterior mitral leaflet and may have been the source of the free-floating ball thrombus. The second case was a 79-year-old female with chronic renal failure who underwent mitral valve replacement 11 years prior to admission. She had been dependent on hemodialysis for 10 years, and had suffered several recent transient cerebral ischemic attacks. Computed tomography showed a ring-shaped, high-density area in the left atrium and transthoracic echocardiography revealed a floating ball thrombus in the left atrium. Thrombectomy was performed, but the patient died as a result of postoperative pneumonia 2 months later. Case 2 appears to be the first reported case of a ball thrombus in a hemodialysis patient who had previously undergone mitral valve replacement.

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

Cited by 6 publications

References 4 publications

Free‐Floating Left Atrial Ball Thrombus Following Mitral Valve Replacement

Free‐Floating Left Atrial Ball Thrombus Following Mitral Valve Replacement

A giant and double-walled left atrial ball thrombus complicating a mitral stenosis: case report—a truck tire into the heart

Two Cases of a Free-Floating Ball Thrombus in the Left Atrium.

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