Ball valve thrombus ppt

2 moving balls in left atrium

1. TWO MOVING OBJECTS IN LEFT ATRIUM Dr Anup Pusate * Dr Sunil Washimkar ** Dr Pritesh Pawar * Dr Rohan Parikh* Dr Amey Bheedkar * Dr Pradeep Deshmukh *** Dr Mukund Deshpande **** Cardiology Dept, GMC-SSH Nagpur * Senior Resident; **Assistant Professor; ***Associate Professor; ****Professor & HOD Echo CME Cases- Cardiac Masses

2. CASE DETAILS A 45 years old lady presented with complaints of: Breathlessness (NYHA class II) since 8 years PND since 15days Stroke with hemiparesis of left side of body since 7 days

3. Examination Pulse- 98/min, regular; BP- 94/60 mmHg S1 loud, Mid diastolic murmur grade 3/6 at apex present ECG- Sinus tacchycardia , right axis deviation , left atrial enlargement 2D-Echo and TEE: Rheumatic heart disease, Severe Mitral Stenosis, Severe PAH and two moving thrombi in Left atrium of 23x16 and 24x18mm . Treatment: Mitral Valve Replacement with Thrombus removal done

4. Welch diagnostic criteria for Ball Valve Thrombus Entire absence of attachment of thrombus with consequent free motility Imprisonment in consequence of an excess in diameter of first narrowing in the circulatory passage ahead of it Reference: Welch W. thrombosis In. Allbutts System of Medicine. Macmillon ; London 1899.vol 6, p.720.

5. Incidence: LA thrombus is present in mitral stenosis in 17 %. Atrial fibrillation doubles the risk. In a study of 490 patients in Pondichery with RHD and mitral stenosis, 169 were found to have thrombus in LA or LAA but none have ball valve thrombus . Conclusion: though literature has mentioned several reports of Ball valve thrombus but its occurrence is rare and that too of two moving ball valve thrombus without embolisation is very rare .