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Two cases of a free-floating ball thrombus in the left atrium
Toshio Kaneda1, Junzo Iemura, Iwao Michihata
1Department of Cardiovascular Surgery, Kinki University School of Medicine, Osaka, Japan. toshio_kaneda@hotmail.com
Insights
Free-floating ball thrombi in the left atrium are rare and dangerous. This study presents two cases, highlighting diagnostic challenges and management strategies for these unusual cardiac masses.
Area of Science:
- Cardiology
- Cardiac Surgery
- Diagnostic Imaging
Background:
- Free-floating ball thrombi in the left atrium are uncommon cardiac masses.
- These thrombi pose significant risks, including fatal systemic emboli and left ventricular inflow obstruction.
Observation:
- Two cases of left atrial ball thrombi are presented.
- Case 1 involved a 59-year-old female with mitral stenosis and atrial fibrillation presenting with dyspnea.
- Case 2 involved a 79-year-old female with end-stage renal disease on hemodialysis and a history of transient cerebral ischemic attacks.
Findings:
- Transthoracic echocardiography and computed tomography were crucial in diagnosing the ball thrombi.
- Emergency thrombectomy and mitral valve replacement were successful in Case 1.
- Case 2, the first reported instance in a hemodialysis patient post-mitral valve replacement, resulted in mortality due to postoperative pneumonia.
Implications:
- Early and accurate diagnosis of left atrial ball thrombi is critical for timely intervention.
- Management strategies should be individualized based on patient comorbidities and thrombus characteristics.
- This highlights the importance of considering rare cardiac pathologies in patients with complex medical histories.
Abstract:
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.