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Left atrium ball thrombus in a patient with hemorrhagic cerebral infarction

Shota Yasuda1, Shigehiko Tokunaga, Yusuke Matsuki

  • 1Department of Cardiovascular Surgery, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.

The Annals of Thoracic Surgery
|December 4, 2013
PubMed

Insights

A large left atrial ball thrombus caused stroke symptoms in a 72-year-old man. Emergency surgery successfully removed the mass, preventing further brain hemorrhage with careful anticoagulation management.

Area of Science:

  • Cardiology
  • Neurology
  • Cardiovascular Surgery

Background:

  • A 72-year-old male presented with left hemiparesis and multiple hemorrhagic cerebral infarctions on CT scan.
  • Cerebral infarctions can be caused by embolic events originating from the heart.

Observation:

  • Transesophageal echocardiography revealed a large, mobile left atrial mass nearly obstructing the mitral valve during diastole.
  • The mass was identified as a ball thrombus upon pathological examination.

Findings:

  • Emergency surgical removal of the left atrial mass was successfully performed.
  • Anticoagulation was carefully managed using a reduced heparin dose and nafamostat mesilate infusion during extracorporeal circulation to mitigate hemorrhage risk.
  • Postoperative CT scans showed no evidence of increased cerebral hemorrhage.

Implications:

  • This case highlights the importance of considering cardiac embolic sources in patients with stroke, even with hemorrhagic infarctions.
  • Effective surgical management combined with cautious anticoagulation strategies can prevent further embolic events and manage hemorrhage risk.
  • Prompt diagnosis and intervention for large left atrial masses are crucial for improving patient outcomes and preventing severe neurological complications.

Keywords:
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