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Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
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Left Atrial Ball Thrombus Captured on Echocardiography: The Ping-Pong Ball and the Hole-in-One

Younes El Bassiri1, Yeqian Shen1, Shusheng Liao2

  • 1Department of Cardiac Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.

JACC. Case Reports
|July 18, 2026
PubMed

Insights

Left atrial ball thrombus can cause fatal mitral obstruction. Early surgical intervention is crucial for survival in patients with this condition, as demonstrated in a case series.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery

Background:

  • Left atrial ball thrombus is a rare but potentially life-threatening condition.
  • Atrial fibrillation and lack of anticoagulation are risk factors.
  • This thrombus can lead to acute mitral obstruction.

Purpose of the Study:

  • To highlight the clinical presentation and outcomes of left atrial ball thrombus.
  • To emphasize the role of imaging in diagnosis.
  • To underscore the importance of timely surgical intervention.

Main Methods:

  • Case series review of two patients with left atrial ball thrombus.
  • Utilized echocardiography, CT, and histopathology for diagnosis and characterization.
  • Compared outcomes based on treatment decisions (surgical resection vs. conservative management).

Main Results:

  • Patient 1, with severe mitral stenosis, underwent successful surgical resection and survived.
  • Patient 2, with atrial fibrillation alone, experienced fatal acute mitral obstruction (hole-in-one mechanism) after declining surgery.
  • Echocardiography was instrumental in visualizing the obstruction.

Conclusions:

  • Left atrial ball thrombus poses a significant risk of fatal acute mitral obstruction.
  • Prompt surgical intervention can alter the outcome and improve survival.
  • This emphasizes the critical need for early diagnosis and management.
Abstract

Keywords:
atrial fibrillationcardiogenic shockechocardiographyhole-in-oneleft atrial ball thrombusmitral stenosis

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