Two-dimensional echocardiographic demonstration of left atrial thrombi in patients with prosthetic mitral valves.

Abstract

Although M-mode echocardiography (MME) is not a reliable method for detecting left atrial thrombi, recent reports suggest that two-dimensional echo (2DE) may be more effective than MME in identifying intracardiac thrombi. In three patients with prosthetic mitral valves who presented with either arterial embolization or prosthetic valvular dysfunction, 2DE demonstrated left atrial masses consistent with thrombi, while MME was either negative (two patients) or suspicious (one patient) for left atrial thrombus. Thrombi were documented by surgical or postmortem examination in all cases. Clear delineation of the atrial cavity and the margins of the masses, visualization on multiple echocardiographic views and comparison of serial examinations were helpful in identifying these masses as thrombi. In addition, the masses visualized had certain patterns of motion which seem unique and may allow characterization of atrial masses as thrombi.

Left atrial ball valve thrombus

“…Our patient had severe mitral stenosis and moderately severe aortic stenosis of rheumatic origin. Infrequently, ball valve thrombus has been described in patients with mechanical mitral prosthetic valve, 5 bio-prosthetic valve, 6 in isolated severe aortic stenosis, 7 and in patients with no valvular heart disease. 8 The reason for typical spherical shape could be because of fresh clot being layered out concentrically as it spins around the atrium.…”

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

“…Recently the routine use of echocardiography, magnetic resonance imaging, or computed tomography permits antemortem diagnosis. Conditions such as atrial fibrillation, mitral stenosis, left atrial dilatation, severe left ventricular dysfunction, and prosthetic mitral valves are associated with a propensity toward left atrial thrombus formation, cardiac embolism or both [4][5][6]. Recently, Acikel et al [7] have reported a freefloating right atrial thrombus in a patient with tricuspid stenosis and atrial fibrillation.…”

Non-Invasive Diagnosis of a Free-Floating Left Atrial Thrombus With Emphasis on Two- Dimensional Echocardiographic Features

“…[6][7][8][9][10][11][12] This unique motion should serve as a diagnostic aid for the identification of free-floating left atrial thrombi. We recognize the possibility that a dislodged clot or tumor of the left atrial cavity could produce a pattern of mobility as set forth for the free-floating thrombus.…”