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"Ping-pong" in the heart: a case report and literature review
Yuantao Hou1, Luyang Jiang1, Ting Hai1
1Department of Anesthesiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
Insights
Ball thrombus, a rare cardiac condition, requires prompt diagnosis and surgical intervention. Echocardiography is crucial for real-time monitoring during urgent thrombectomy to improve patient outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Diagnostic Imaging
Background:
- Ball thrombus is a rare but life-threatening cardiac condition.
- Timely diagnosis and management are critical for improving patient prognosis.
- This report details a case and literature review of ball thrombus.
Observation:
- A 75-year-old woman with mitral stenosis presented with palpitations and chest distress.
- Transthoracic echocardiography revealed a mobile mass in the left atrium, later identified as a ball thrombus.
- Transesophageal echocardiography detected an additional mass in the left atrial appendage.
Findings:
- The patient underwent successful left atrial mass removal and mitral valve replacement.
- Literature review identified 19 cases (2015-2024) with a mean age of 54.8 years.
- Heart failure was the primary symptom in 11 cases, often associated with mitral valve disease or atrial fibrillation.
Implications:
- Urgent thrombectomy is recommended for ball thrombus.
- Echocardiography serves as a vital tool for real-time surgical monitoring.
- Prompt surgical intervention can significantly improve patient outcomes in cases of ball thrombus.
Background:
Ball thrombus is rare and life-threatening. The correct diagnosis and timely management are key to improving patient prognosis. Here, we present a case report and literature review of ball thrombus.
Case Presentation:
A 75-year-old woman presented to our outpatient clinic because of palpitations and chest distress for 8 months. She was diagnosed mitral stenosis, and transthoracic echocardiography (TTE) showed a round mass attached to the left atrial (LA) wall. Before anesthesia induction, TTE found that the mass has dropped from the LA wall, and was spinning in the LA causing intermittent obstruction of the valve. Anesthesia induction was then carried out under TTE monitoring, and transesophageal echocardiograph found another mass in the LA appendage after intubation. She underwent LA mass removal and mitral valve replacement, and was discharged uneventfully. Histopathology confirmed the diagnosis of thrombus. Our literature review identified 19 cases of ball thrombus between 2015 and 2024. The average age was 54.8 (range 3-88) years. Heart failure was present as the initial symptom in 11 cases, and most patients had mitral valve disease or concomitant with atrial fibrillation. 12 cases received surgery, and 7 received medical treatment only. 2 deaths occurred, one due to the obstruction of left ventricular inflow tract and the other due to the worsening of heart failure.
Conclusion:
Ball thrombus is rare in clinical settings. Urgent thrombectomy should be performed as soon as possible, and echocardiography can be used for real-time monitoring during surgery.
