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Published on: June 11, 2019
Large Free-Floating Left Atrial Ball Thrombus With Intermittent Mitral Valve Occlusion
Amitoj Singh1, Usama Nasir1, Sherif B Labib1
1Division of Cardiovascular Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA.
Insights
An elderly man with atrial fibrillation had a large mass discovered in his left atrium during preoperative evaluation. This cardiac mass was found to intermittently obstruct the mitral valve, posing a significant risk.
Area of Science:
- Cardiology
- Cardiac Surgery
- Diagnostic Imaging
Background:
- Atrial fibrillation is a common arrhythmia.
- Preoperative evaluations are crucial for identifying potential surgical risks.
- Cardiac masses can lead to significant complications.
Purpose of the Study:
- To report a case of a large left atrial mass found incidentally.
- To highlight the diagnostic utility of echocardiography in identifying cardiac masses.
- To describe the clinical implications of a mobile atrial mass on mitral valve function.
Main Methods:
- Transthoracic echocardiography (TTE) for initial cardiac mass detection.
- Transesophageal echocardiography (TEE) for detailed mass characterization and dynamic assessment.
- Preoperative evaluation for elective left nephrectomy.
Main Results:
- A large, free-floating left atrial mass was identified via TTE.
- TEE confirmed the mass's mobility and intermittent obstruction of the mitral valve.
- The patient had a history of atrial fibrillation and was undergoing evaluation for nephrectomy.
Conclusions:
- Echocardiography is essential for diagnosing cardiac masses.
- Mobile atrial masses pose a risk of valvular obstruction.
- Prompt diagnosis and management are critical for patients with cardiac masses.
Abstract:
An 83-year-old man with known history of atrial fibrillation presented for preoperative evaluation for elective left nephrectomy for cancer. Transthoracic echocardiogram revealed a large, free-floating, left atrial mass. Further profiling with transesophageal echocardiogram showed a free-floating mass intermittently obstructing the mitral valve.
