Left Atrial Free-Floating Ball Thrombus in a Case of Hyperthrophic Cardiomyopathy

Abstract

Left atrial free-floating ball thrombus is a rarely seen pathology in the absence or presence of mitral valve disease. This pathologic condition carries high risks of embolic complications and deterioration of hemodynamics. The case reported here is a 34-year-old woman who had been followed-up by another center with the diagnosis of hypertrophic cardiomyopathy (HCM) was admitted to our emergency department in cardiogenic shock due to left atrial free-floating ball thrombus partially obstructed the left ventricular inflow. Emergency surgery was undertaken to remove the ball mass, additionally septal myectomy and mitral valve replacement were performed. Pathologic examination of the mass confirmed the thrombus formation. This rare case of left atrial free floating ball thrombus associated with HCM is presented and current literature is reviewed.

Free Floating Left Atrial Thrombus Disappearing during Echocardiography

“…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).…”

Left Atrial Ball-Shaped Thrombus with Concomitant Biatrial Appendage Thrombi in a Patient with Prior Mitral Valve Replacement

“…Free-floating ball-shaped thrombus in the left atrium is a rare finding among patients with mitral valve disease with or without a history of valve replacement surgery [3–8]. This type of thrombus was reported to form in the absence of valve disease and also to recur despite adequate anticoagulation [10, 11]. The precise mechanism behind the occurrence of a free-floating ball-shaped thrombus remains uncertain.…”

Occult left atrial ball-like thrombus in a patient referred for surgical removal of suspected cerebellum tumor.

“…Left atrial ball thrombus is a rare condition, first recognized in autopsy in the early XIX century. Left atrial free-floating thrombus is mostly associated with the disease of the mitral valve [ 12 , 13 ] but has also been acquainted in association with atrial fibrillation [ 14 ] and hypertrophic cardiomyopathy [ 15 ]. The etiology of ball thrombus formation in the lack of structural heart disease or AF is mostly unknown, but metastatic carcinoma is a diagnosis worth giving consideration to [ 16 ].…”