INTERESTING ECHO OF THE MONTH
A 54 yrs female presented with symptoms of breathlessness and palpitations. She had undergone balloon mitral valvuloplasty (BMV) 10 years prior and she was in atrial fibrillation with a rapid heart rate. She had a severe mitral restenosis and was referred for transesophageal assessment for repeat BMV. She was on oral anticoagulants, despite which she suffered a TIA. Her most recently recorded PT / INR measured 1.5. Her TEE clips are shown What is the Diagnosis??
Large thrombus within the LA appendage.
The TEE clip of SAX & four chamber view shows dilated LA with spontaneous contrast and presence of a thrombus within the LA appendage. The thrombus measures 38 mm x 12 mm. It is important to assess size, consistency and mobility of this thrombus. Rarely, if the thrombus is located entirely in the LA appendage, is small, organised, and not mobile, BMV can be attempted with some caveats. In this patient, however, the clot was large and protruding into the main LA body, and this patient was hence referred for surgery