[A left atrial appendage thrombus without mitral stenosis--a successful case of removal]

Successful thrombectomy for left atrial ball thrombus without mitral stenosis is presented. A 62-year-old man was admitted to our department because of intermittent claudication. Arteriography demonstrated complete occlusion in bilateral superficial femoral arteries, however, the arterial wall was much smooth, suggesting thrombo-embolism rather than arteriosclerosis obliterans. The transthoracic echocardiography revealed no abnormal lesion in mitral apparatus and in left atrial cavity. The bypass operation was carried out for arterial occlusion, when the intraoperative transesophageal echocardiography showed the ball thrombus in left atrial appendage. The urgent operation was successfully carried out on 14th postoperative day after bypass operation. The thrombus occupied almost all the left atrial appendage, and its size was 24 x 19 x 13 mm. The transesophageal echocardiography was useful in diagnosis for left atrial appendage thrombus. Once the diagnosis was made for large and movable left atrial thrombus, immediate surgical therapy should be recommended to avoid serious complications and sudden death.