Mitral Jamming by Left Atrial Mobile Thrombus in Severe Rheumatic Mitral Stenosis

Figure 1. Electrocardiography Showed Rapid Atrial Fibrillation

Figure 2. Chest X-Ray Imaging Showing an Increased Cardiothoracic Ratio With Cephalization of Pulmonary Vascular Markings

Figure 3. Baseline Transthoracic Echocardiography (A and B) Parasternal long-axis and apical 4-chamber view showing a mobile left atrial mass (24 × 24 mm) that bulged into the left ventricular inflow tract. (C) Continuous wave Doppler showing severe mitral stenosis with a high mean mitral valve gradient of 23.59 mm Hg. (D) Apical 4-chamber view demonstrating severe tricuspid regurgitation with a high probability of pulmonary hypertension.

Figure 4. Histopathology Sample From Left Atrial Thrombus (A) Macroscopic view of the excised thrombus measuring 62 × 24 × 15 mm3, appearing rubbery and brown. (B to D) Histopathological examination by hematoxylin-eosin staining showing an organized thrombus with dense fibrin networks, interspersed inflammatory cells, and areas of granulation tissue, with no evidence of malignancy (40×, 100×, and 400×).

Figure 5. One-Week Post-Discharge Transthoracic Echocardiography Evaluation (A) Parasternal long-axis view showing left atrial thrombus resolution after thrombectomy with appearance of the mechanical prosthetic mitral valve. (B) The mitral valve area by pressure-half time was 5.0 cm2 with a significant reduction in mean mitral valve gradient to 2.73 mm Hg.

Figure 6. Prosthetic Mitral Valve in Apical 4-Chamber View Another view of transthoracic echocardiography evaluation post-discharge. (A) Apical 4-chamber view showing acoustic shadow from a prosthetic mitral valve. (B) Mitral valve parameters after thrombectomy and mitral valve replacement.

Visual Summary. Timeline of the Case AF = atrial fibrillation; ALI = acute limb ischemia; ICCU = intensive cardiac care unit; LA = left atrial; LVEF = left ventricular ejection fraction; MA = mitral stenosis; MVG = mitral valve gradient; MVR = mitral valve replacement; RHD = rheumatic heart disease; TAPSE = tricuspid annular plane systolic excursion; TTE = transthoracic echocardiography.