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[Successful removal of ball thrombus in the left atrium]
Insights
Echocardiography identified left atrial ball thrombus in two patients with severe mitral stenosis, enabling successful surgical removal. These cases highlight echocardiography
Area of Science:
- Cardiology
- Cardiac Surgery
- Diagnostic Imaging
Background:
- Severe mitral stenosis poses risks, including thrombus formation in the left atrium.
- Left atrial ball thrombus is a rare but serious complication, often associated with significant mitral valve disease.
- Prompt diagnosis and surgical intervention are crucial for managing left atrial ball thrombus.
Observation:
- Two patients with severe mitral stenosis presented with symptoms suggestive of embolic events.
- Echocardiography revealed a mobile, ball-like thrombus within the left atrium in both cases.
- Surgical excision of the left atrial thrombus was performed under extracorporeal circulation.
Findings:
- The first patient had a 30x40 mm, 20g thrombus; the second had a 20x26 mm, 5g thrombus.
- Both thrombi exhibited a laminated internal structure upon examination.
- Mitral valve replacement with Björk-Shiley prostheses was performed in both patients.
Implications:
- Echocardiography is a vital tool for preoperative diagnosis of left atrial ball thrombus.
- Surgical management of left atrial ball thrombus in the context of mitral stenosis can be successful.
- These cases underscore the importance of considering thrombus formation in patients with severe mitral valve disease and embolic symptoms.
Abstract:
Two cases of left atrial ball thrombus associated with severe mitral stenosis in which echocardiography provided the clue to the diagnosis preoperatively were reported. First case was a 58 years old man who was admitted because of dyspnea and frequent syncopal attacks. An echocardiographic examination revealed a tight mitral stenosis and a floating ball thrombus in the left atrium. Under the extracorporeal circulation, the ball thrombus, 30 X 40 mm in size, weight 20 g was taken out. The other case was a 51 years old woman who had undergone surgery for closed mitral commissurotomy 14 years ago. She had a episode of syncope attack and a sudden loss of consciousness. The removed thrombus was 20 X 26 mm in size and weighed 5 g. Their cut surfaces showed an laminated structure in both cases. These mitral valves were replaced by Björk-Shiley prosthetic valves.