Abstract
A free-floating thrombus in the left atrium without attachment to either the atrial wall or the mitral valve is extremely rare. We describe a case in a 79-year-old woman with chronic atrial fibrillation and a recent stroke who had undergone mitral valve replacement 25 years previously and coronary artery bypass grafting 5 years previously. Redo cardiac surgery represents a clinical challenge due to a higher rate of peri-operative morbidity and mortality. Median re-sternotomy can be particularly difficult in patients with functioning coronary artery grafts, where the risk of graft injury is a significant concern. Prompt surgical intervention was carried out, and to avoid the challenge of re-sternotomy in this patient with two prior thoracotomies, we successfully removed the thrombus by a right minithoracotomy approach without aortic cross-clamping. There was no postoperative occurrence of a new stroke or aggravation of the pre-existing stroke.
Similar content being viewed by others
References
Kaneda T, Iemura J, Michihata I, Zhang ZW, Oka H, Otaki M, et al. Two cases of a free-floating ball thrombus in the left atrium. Circ J. 2002;66:869–71.
Morales D, Williams E, John R. Is resternotomy in cardiac surgery still a problem? Interact Cardiovasc Thorac Surg. 2010;11:277–86.
Tabak SW, Maurer G. Echocardiographic detection of free-floating left atrial thrombus. Am J Cardiol. 1984;53:374–5.
Marcu CB, Kramer C, Donohue TJ. Giant left atrial thrombus successfully treated with anticoagulation. Heart Lung Circ. 2007;16:55–6.
Chen T, Lejemtel TH, Garcia J, Gordon GM, Spevack DM. Free-floating left atrial ball thrombus following mitral valve replacement. Echocardiography. 2005;22:438–40.
Maruyama M, Kuriyama Y, Sawada T, Yamaguchi T, Fujita T, Omae T. Brain damage after open heart surgery in patients with acute cardioembolic stroke. Stroke. 1989;20:1305–10.
Thompson MJ, Behranwala A, Campanella C, Walker WS, Cameron EW. Immediate and long-term results of mitral prosthetic replacement using a right thoracotomy beating heart technique. Eur J Cardiothorac Surg. 2003;24:47–51.
Botta L, Cannata A, Bruschi G, Fratto P, Taglieri C, Russo CF, et al. Minimally invasive approach for redo mitral valve surgery. J Thorac Dis. 2013;5:S686–93.
Umakanthan R, Leacche M, Petracek MR, Kumar S, Solenkova NV, Kaiser CA, et al. Safety of minimally invasive mitral valve surgery without aortic cross-clamp. Ann Thorac Surg. 2008;85:1544–9.
Loulmet DF, Patel NC, Jennings JM, Subramanian VA. Less invasive intracardiac surgery performed without aortic clamping. Ann Thorac Surg. 2008;85:1551–5.
Conflict of interest
The authors have declared that no conflict of interest exists.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hisatomi, K., Hashizume, K., Tanigawa, K. et al. Free-floating left atrial ball thrombus after mitral valve replacement with patent coronary artery bypass grafts: successful removal by a right minithoracotomy approach without aortic cross-clamp. Gen Thorac Cardiovasc Surg 64, 333–336 (2016). https://doi.org/10.1007/s11748-014-0462-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11748-014-0462-2