Fraser A G, Angelini G D, Ikram S, Butchart E G
Department of Cardiology, University Hospital of Wales, Health Park, Cardiff, U.K.
Eur Heart J. 1988 Jun;9(6):672-7. doi: 10.1093/oxfordjournals.eurheartj.a062560.
The echocardiographic features of left atrial ball thrombus associated with mitral stenosis are reviewed, and some previously unpublished cross-sectional echocardiographic findings presented. In one patient who had a large free-floating ball thrombus there was variation in its echocardiographic appearance; the thrombus was removed uneventfully at surgery. In another patient who had a pedunculated but immobile ball thrombus, a stalk was identified which attached it to the inter-atrial septum; this patient died suddenly before surgery could be performed, due to detachment of the thrombus and obstruction of the mitral valve orifice. Cross-sectional echocardiography is clearly superior to M-mode imaging in the detection of atrial thrombi, and variable appearances may help differentiation of thrombus from myxoma. Whether or not a ball thrombus appears mobile, emergency thrombectomy and mitral valve replacement is indicated, because of the risk of obstruction of the mitral valve.
本文回顾了与二尖瓣狭窄相关的左心房球形血栓的超声心动图特征，并展示了一些此前未发表的横断面超声心动图检查结果。在一名患有巨大游离球形血栓的患者中，其超声心动图表现存在变化；该血栓在手术中顺利取出。在另一名患有带蒂但固定不动的球形血栓的患者中，发现了一个将血栓附着于房间隔的蒂；该患者在手术前突然死亡，原因是血栓脱落并阻塞二尖瓣口。在检测心房血栓方面，横断面超声心动图明显优于M型成像，且血栓外观的变化可能有助于鉴别血栓与黏液瘤。无论球形血栓是否表现为可移动，由于存在二尖瓣阻塞的风险，均应进行紧急血栓切除术和二尖瓣置换术。
