title: Free-floating left atrial ball thrombus after mitral valve replacement with patent coronary artery bypass grafts: successful removal by a right minithoracotomy approach without aortic cross-clamp.
abstract: A free-floating thrombus in the left atrium without attachment to either the atrial wall or the mitral valve is extremely rare. We describe a case in a 79-year-old woman with chronic atrial fibrillation and a recent stroke who had undergone mitral valve replacement 25 years previously and coronary artery bypass grafting 5 years previously. Redo cardiac surgery represents a clinical challenge due to a higher rate of peri-operative morbidity and mortality. Median re-sternotomy can be particularly difficult in patients with functioning coronary artery grafts, where the risk of graft injury is a significant concern. Prompt surgical intervention was carried out, and to avoid the challenge of re-sternotomy in this patient with two prior thoracotomies, we successfully removed the thrombus by a right minithoracotomy approach without aortic cross-clamping. There was no postoperative occurrence of a new stroke or aggravation of the pre-existing stroke.
authors.affiliation: Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. khisatomi@nagasaki-u.ac.jp.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Hisatomi
authors.affiliation: Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Hashizume
authors.affiliation: Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Tanigawa
authors.affiliation: Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Miura
authors.affiliation: Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Matsukuma
authors.affiliation: Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Yokose
authors.affiliation: Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Tessho
authors.initials: T
authors.lastname: Kitamura
authors.affiliation: Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Shimada
authors.affiliation: Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Kiyoyuki
authors.initials: K
authors.lastname: Eishi
mesh_terms: D000368:Aged; D001011:Aorta / Q000601:surgery; D001281:Atrial Fibrillation / Q000601:surgery; D006348:Cardiac Surgical Procedures; D003250:Constriction; D001026:Coronary Artery Bypass; D005260:Female; D006325:Heart Atria / Q000601:surgery; D006331:Heart Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D056346:Sternotomy; D020521:Stroke / Q000150:complications; D013525:Surgical Instruments; D013908:Thoracotomy / Q000379:methods*; D013927:Thrombosis / Q000601:surgery*
keywords: Atrium; Coronary artery bypass grafts; Minimally invasive surgery; Mitral valve replacement; Thrombosis
references.citation: Circ J. 2002 Sep;66(9):869-71
references.pmid: 12224829
references.citation: Ann Thorac Surg. 2008 May;85(5):1551-5
references.pmid: 18442536
references.citation: Heart Lung Circ. 2007 Feb;16(1):55-6
references.pmid: 17045526
references.citation: Am J Cardiol. 1984 Jan 15;53(2):374-5
references.pmid: 6695752
references.citation: J Thorac Dis. 2013 Nov;5 Suppl 6:S686-93
references.pmid: 24251029
references.citation: Stroke. 1989 Oct;20(10):1305-10
references.pmid: 2799861
references.citation: Eur J Cardiothorac Surg. 2003 Jul;24(1):47-51; discussion 51
references.pmid: 12853044
references.citation: Ann Thorac Surg. 2008 May;85(5):1544-9; discussion 1549-50
references.pmid: 18442535
references.citation: Echocardiography. 2005 May;22(5):438-40
references.pmid: 15901298
references.citation: Interact Cardiovasc Thorac Surg. 2010 Sep;11(3):277-86
references.pmid: 20525761