Key result
Urgent surgery successfully removes giant free-floating left atrial thrombus despite normal mechanical mitral valve gradients.
Why the study?
Left atrial masses in patients with atrial fibrillation and mechanical mitral prostheses are diagnostically challenging and require prompt management to prevent complications.
Case Report (n=1)
A free-floating left atrial thrombus near a mechanical mitral prosthesis may require urgent surgery to prevent embolic or obstructive complications, even when transprosthetic gradients are normal.
BACKGROUND: Left atrial (LA) masses may be diagnostically challenging in patients with atrial fibrillation, previous mitral valve surgery, and severe LA remodeling. CASE SUMMARY: A 77-year-old woman with permanent atrial fibrillation and a bileaflet mechanical mitral prosthesis underwent pacemaker implantation. Predischarge transthoracic echocardiography revealed a large LA mass. Transesophageal echocardiography showed a heterogeneous mobile mass, raising the differential diagnosis of thrombus vs myxoma. After intravenous unfractionated heparin, repeat transesophageal echocardiography demonstrated a giant free-floating mass intermittently impinging on the prosthetic discs without increased transprosthetic gradients. Contrast-enhanced computed tomography showed no postcontrast enhancement. Urgent surgery removed the mass, which was macroscopically consistent with thrombus. DISCUSSION: Serial transesophageal echocardiography, particularly with 3-dimensional imaging, can identify dynamic changes in mass mobility and guide prompt management before embolic or prosthetic obstructive complications occur. TAKE-HOME MESSAGE: A free-floating LA thrombus near a mechanical mitral prosthesis may require urgent surgery despite normal gradient.
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Niro et al. (2026) conducted a case report in Left atrial thrombus (n=1). Urgent surgery was evaluated. Urgent surgery was required to remove a giant free-floating left atrial thrombus in a 77-year-old woman with a mechanical mitral prosthesis despite normal transprosthetic gradients.
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