Hot Air Balloon in the Left Atria

Area of Science:

• Cardiology
• Cardiac Surgery
• Diagnostic Imaging

Background:

• A 54-year-old patient with hypertension, dyslipidemia, and diabetes underwent mitral valve replacement with a biologic prosthesis.
• Incidental finding of reduced left atrial filling during computed tomography for breast cancer staging.

Observation:

• A sizable, echogenic mass (3.0 cm × 3.5 cm) was detected attached to the mitral prosthesis ring within the left atrium.
• Mild periprosthetic regurgitation was observed.
• The patient presented with shortness of breath and fatigue, which improved with furosemide.

Findings:

• Transesophageal echocardiogram revealed a displaced biologic mitral valve prosthesis with a mass.
• Cardiac magnetic resonance imaging was planned for mass characterization.
• Anticoagulation therapy was initiated due to high suspicion of thrombus.

Implications:

• The cardiac mass significantly decreased in size over 4 weeks, resolving by the 6th week.
• This case emphasizes the importance of multimodal imaging in managing cardiac masses.
• A comprehensive approach involving anticoagulation and serial echocardiography is crucial for diagnosis and treatment.