Extensive left atrial thrombus invading pulmonary veins and mitral valve in severe mitral stenosis

Severe mitral stenosis is a valvular heart disease that obstructs blood flow from the left atrium to the left ventricle, leading to impaired ventricular filling, left atrial dilatation, atrial fibrillation, and thromboembolic events. We report the case of a female patient who presented with shortness of breath (NYHA Class-II) for six months. On examination, a low-pitched murmur was heard at the apex; other systemic examination findings were unremarkable. TTE/TEE revealed left atrial dilatation with LAVI of 120 ml/m², a large left atrial thrombus, severe rheumatic mitral stenosis, and moderate mitral regurgitation with preserved systolic function, leading to MVR. The thrombus was firmly adherent; after failed attempts to create a plane, it was successfully removed using a polypropylene needle. The unusually small mitral annulus was managed by creating fenestrations. This case highlights the importance of preoperative evaluation and individualized surgical approaches for improved outcomes.