title: Mural left atrial thrombus: a hidden danger accompanying cardiac surgery.
abstract: OBJECTIVE
  To emphasize a potentially lethal condition that is virtually impossible to diagnose preoperatively.
  
  
  METHODS
  Case report with review of the literature.
  
  
  METHODS
  University Hospital.
  
  
  METHODS
  The patient requiring urgent surgery for heart failure related to severe aortic stenosis and mild mitral stenosis with poor ventricular function. The patient was elderly and suffered from atrial fibrillation.
  
  
  METHODS
  Preoperative transesophageal echocardiography followed by mitral valve repair and aortic valve replacement.
  
  
  METHODS
  Clinical outcome and pathological results.
  
  
  RESULTS
  Although preoperative TEE demonstrated no left atrial appendage abnormality. After cardiac manipulation prior to the institution of cardiopulmonary bypass a large left atrial mural thrombus was mobilized from the atrial wall and was free floating in the left atrium.
  
  
  CONCLUSIONS
  For high risk patients TEE should be applied intraoperatively to avoid undiagnosed left atrial clot dislodgement.
authors.affiliation: Department of Surgery, Robert Wood Johnson Medical School, University of Medicine & Dentistry of New Jersey, USA.
authors.forename: D
authors.initials: D
authors.lastname: Leslie
authors.forename: T S
authors.initials: TS
authors.lastname: Hall
authors.forename: S
authors.initials: S
authors.lastname: Goldstein
authors.forename: D
authors.initials: D
authors.lastname: Shindler
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D005500:Follow-Up Studies; D006325:Heart Atria; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology*