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Giant Floating Right Atrial Thrombus Following Balloon Mitral Valvuloplasty

Georgina Fuertes Ferre1*, Maria Carmen Aured Guallar2, Esther Sánchez Insa1 and Jose Gabriel Galache Osuna1



1Interventional Cardiology Unit, Miguel Servet University Hospital, Zaragoza, Spain
2Echocardiography Department, Miguel Servet University Hospital, Zaragoza, Spain


*Corresponding author: Georgina Fuertes Ferre, Paseo de Isabel La Catolica, 1-3, 50009, Zaragoza, Spain, Tel: +34 976765500, Fax: +34 976562565, E-mail: georginaff@hotmail.com.
Clin Med Img Lib, CMIL-1-018, (Volume 1, Issue 2); ISSN: 2474-3682
Published Date: December 06, 2015
Citation: Fuertes-Ferre G, Guallar MCA, Insa ES, Osuna JGG (2015) Giant Floating Right Atrial Thrombus Following Balloon Mitral Valvuloplasty. Clin Med Img Lib 1:018
Copyright: © 2015 Fuertes-Ferre G, et al. This is an open-access content distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



Keywords

Thrombus, Balloon mitral valvuloplasty


Case Report

A 83 years-old woman underwent percutaneous balloon mitral valvuloplasty (PBMV) due to symptomatic rheumatic mitral stenosis. The transesophageal echocardiogram before PBMV revealed no atrial thrombus. PMBV was performed under fluoroscopic guidance. Following PBMV, an obstruction of the catheter lumen was detected. The transthoracic echocardiogram (TTE) showed a giant mass in the right atrium (Figure 1A), free mobile and eventually prolapsing into the right ventricle (Video). The large thrombus was completely removed percutaneously (Figure 1B), confirmed by TTE (Figure 1C). Despite the use of unfractionated heparin, thrombus formation during PBMV can occur. Echocardiographic imaging is crucial for the detection of thrombus, which cannot be identified by fluoroscopy.


Disclosure

There are no potential conflicts of interest to declare.


Role of the funding source

No funding was received related to this manuscript.



Figure 1: A) Transthoracic Echocardiography (TTE) showing the large mass/thrombus floating in the right atrium (arrow); B) Fresh thrombus removed using transcatheter aspiration technique. C) TTE showing no evidence of residual thrombus in the right atrium. RA: Right atrium, LA: left atrium, RV: right ventricle






Video: Transthoracic echocardiography imaging of the free right atrial thrombus highly mobile, eventually prolapsing into the right ventricle.



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