Oryoji A, Kawara T, Hara H, Aoyagi S, Kosuga K, Ohishi K
Second Department of Surgery, Kurume University School of Medicine, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1993 Apr;41(4):699-703.
A free-floating ball thrombus in the left atrium is a rare clinical problem with potentially catastrophic consequences. Thus, early diagnosis and prompt surgical intervention are mandatory. This report dealt with a free-floating ball thrombus in the left atrium in a case without mitral valve disease. A 82-year-old woman was presented with dyspnea, hypotension, and fever. On admission she had cardiac arrhythmia, but had no cardiac murmur. The electrocardiogram revealed atrial fibrillation. Chest X-ray examination showed marked cardiomegaly (cardio-thoracic rate; 94%) without evidence of pulmonary venous congestion. Coagulation studies revealed decreased coagulability. Transthoracic and transesophageal echocardiograms showed retention of pericardial effusion, and a free-floating ball thrombus in the dilated left atrium. Thickening, calcification, and restricted motion of the mitral leaflets were not observed by echocardiography. Removal of the free-floating ball thrombus in the left atrium was successfully performed on the emergency basis. The intact mitral valve was also confirmed at operation. The patient recovered uneventfully. Usefulness of echocardiography, particularly transesophageal echocardiography, for precise diagnosis and intraoperative management of a free-floating ball thrombus in the left atrium is discussed.
左心房内自由漂浮的球形血栓是一个罕见的临床问题，可能会导致灾难性后果。因此，早期诊断和及时的手术干预是必不可少的。本报告探讨了一例无二尖瓣疾病的左心房内自由漂浮的球形血栓病例。一名82岁女性出现呼吸困难、低血压和发热。入院时她有心律失常，但无心脏杂音。心电图显示心房颤动。胸部X线检查显示心脏明显增大（心胸比率为94%），无肺静脉淤血迹象。凝血研究显示凝血能力下降。经胸和经食管超声心动图显示有心包积液残留，扩张的左心房内有一个自由漂浮的球形血栓。超声心动图未观察到二尖瓣叶增厚、钙化和活动受限。在紧急情况下成功地摘除了左心房内的自由漂浮球形血栓。术中也证实二尖瓣完好无损。患者恢复顺利。本文讨论了超声心动图，特别是经食管超声心动图，对于精确诊断和术中处理左心房内自由漂浮球形血栓的实用性。
