Left atrial ball thrombus after edge-to-edge mitral valve repair

Area of Science:

• Cardiology
• Vascular Surgery

Background:

• Atrial fibrillation (AF) increases stroke risk due to blood stasis and thrombus formation in the left atrium.
• Anticoagulation therapy, targeting an International Normalized Ratio (INR) of 2-3, is standard for AF-related embolism prevention.
• Previous mitral valve surgery can alter cardiac anatomy, potentially increasing thrombus risk.

Observation:

• Massive left atrial thrombi, including pedunculated ball valve thrombi and free-floating thrombi, can develop despite adequate anticoagulation.
• These thrombi pose significant risks, including systemic embolism, left ventricular inflow obstruction, and sudden death.
• A case of a huge, asymptomatic left atrial ball thrombus in a patient on warfarin after mitral valve surgery is presented.

Findings:

• The presence of a ring and modified valve anatomy post-surgery may contribute to thrombus formation.
• Free-floating ball thrombi in the left atrium are rare but highly hazardous.
• Physical findings can vary significantly between pedunculated and free-floating thrombus types.

Implications:

• Prompt surgical excision of left atrial thrombi is recommended, even in asymptomatic patients.
• This case highlights the potential for unnoticed, massive thrombus formation in high-risk cardiac patients.
• Understanding anatomical modifications post-cardiac surgery is vital for assessing thrombosis risk in AF patients.