Mitral stenosis and free-floating left atrial thrombus: Demonstration of the “hole-in-one” effect by color Doppler echocardiography

Is the thrombus truly free‐floating? A case report

“…When clinical evidence leads to the suspicion of a free‐floating thrombus, echocardiography should be performed immediately. In most published cases, the free‐floating thrombus has been either described by TTE or demonstrated surgically to be spherical or ovoid in shape, but TEE findings were not reported . In the present case, we initially thought that the mass in the LA was a free‐floating thrombus, because it appeared to be spherical, like a ball‐thrombus, on TTE.…”

“…A free‐floating thrombus in the left atrium (LA) is very rare in patients with mitral stenosis (MS). It usually occurs in the setting of dilated LA with stagnant flow, commonly the result of severe rheumatic MS and accompanying atrial fibrillation (AF) . The free‐floating thrombus can produce sudden circulatory arrest and syncope by obstructing the mitral orifice or can cause severe cerebral or peripheral thromboembolic events .…”

“…It usually occurs in the setting of dilated LA with stagnant flow, commonly the result of severe rheumatic MS and accompanying atrial fibrillation (AF). 1 The free-floating thrombus can produce sudden circulatory arrest and syncope by obstructing the mitral orifice or can cause severe cerebral or peripheral thromboembolic events. 2,3 Two-dimensional echocardiography is particularly useful for identifying left atrial free-floating thrombus and for demonstrating its behavior through consecutive cardiac cycles.…”

Free-floating left atrial ball thrombus developed in an 11-year-old child with restrictive cardiomyopathy during sinus rhythm: Manifested as a major thromboembolic event

“…Free-floating left atrial ball thrombus is a rare disorder that usually occurs in the setting of a large, dilated left atrium with stagnant flow, commonly the result of severe rheumatic mitral stenosis and accompanying atrial fibrillation [1]. Wood, who first applied the term ball thrombus to this entity in 1814, described autopsy findings in a 15-yearold girl with rheumatic mitral stenosis [3].…”

“…It usually occurs in the setting of a large, dilated left atrium with stagnant flow, commonly the result of severe rheumatic mitral stenosis and accompanying atrial fibrillation [1,2]. In the present case, we report an 11-year-old child with restrictive cardiomyopathy and sinus rhythm, referred to our hospital with the diagnosis of acute left lower extremity thromboembolism.…”