Left Atrial Thrombus Present: Is That about It?

The left atrium (LA) and its appendage are common sites for the formation of thrombi in patientswithmitral stenosis and atrial fibrillation due to the stasis of blood or a poorly contracting LA. The left atrial thrombus may break into several smaller pieces forming free-floating masses, leading to catastrophic embolic events such as a stroke, systemic embolization, and total or partial obstruction of the left ventricular inflow.1–4 Two-dimensional (2D) echocardiography is not just extremely sensitive in detecting thrombi of the LA, but it is also predictive of a possibility of a thrombus formation by the detection of a spontaneous echo contrast.5–7 Difficulties in the visualization of the left atrial appendage (LAA) using transthoracic echocardiography (TTE) have been easily overcome with the advent of transesophageal echocardiography (TEE), which has near 100% sensitivity in detection of left atrium and left atrial appendage thrombi. Because of their fragility, intracardiac thrombi are at extremely high risk of dislodgement and embolization, leading to adverse sequelae. This can easily happenwith any cardiac manipulation that may occur during caval cannulation, insertion of cardioplegia catheter, or application of aortic cross-clamp. In this case, TEE instantaneously detected the dislodged thrombus following which early bypass was initiated and adverse sequelae averted.