Free-floating thrombus in the left atrium.

From the Second Department of Cardiology, Attikon University Hospital, Athens, Greece. Manuscript received August 23, 2010; accepted September 6, 2010. A72-year-old, asymptomatic patient with a history of permanent atrial fibrillation was admitted to our hospital for an echocardiographic follow-up 6 months after a mitral valve replacement. Two-dimensional transthoracic and transesophageal echocardiography revealed a freely moving mass in the left atrium. Three-dimensional transesophageal echocardiography (3D-TEE) demonstrated a ball-like thrombus (yellow arrows) bouncing around the atrium like a ball in a pinball machine. The mass was striking repeatedly against the mitral valve without obstructing it, due to its large size (A and B, Online Videos 1 and 2). 3D-TEE is a novel echocardiographic technique that helps to evaluate and differentiate a cardiac mass, providing additional information about its shape, size, mobility, attachment point, and spatial orientation (1,2). Blue arrow spontaneous contrast into the left atrium. Ao aorta; LA left atrium; LAA left atrial appendage; LV left ventricle; Mv prosthetic mitral valve. Published by Elsevier Inc. doi:10.1016/j.jacc.2010.09.088