Clinical Image

The Cardiac Origin of an Imminent Cerebral Embolization

Niels Verberkmoes* and Kayan Lam
Department of Cardiothoracic Surgery, Catharina Hospital, Netherlands


*Corresponding author: Niels Verberkmoes, Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, 5623 EJ, Eindhoven, Netherlands


Published: 20 Feb, 2018
Cite this article as: Verberkmoes N, Lam K. The Cardiac Origin of an Imminent Cerebral Embolization. J Heart Stroke. 2018; 3(2): 1049.

Clinical Image

A 72-year-old man suffering from severe aortic stenosis and persistent atrial fibrillation was scheduled for surgical ortic valve replacement (SAVR) and arrhythmia surgery. The use of dabigatran was ceased five days before the procedure. After induction of general anesthesia a transoesophageal echocardiogram (TOE) was performed. This revealed a stalked ovoid mass at the base of the left atrial appendage (LAA) (Panel A). Sternotomy was performed and the patient was supported with extra-corporeal circulation. Due to the slightest surgical manipulation of the left atrium breakage of the stalk occurred. The mass migrated to the roof of the left atrium and made distracting movements towards the left ventricle hereby threatening with thromboembolic complications (Panel B). The mass was removed from the left atrium and was diagnosed as a thrombus (Panel C). Uncomplicated SAVR and arrhythmia surgery were performed. The LAA was closed at the base with an epicardial closure device (Panel D, arrow). The patient recovered well. A left atrial mass is a potential cause of tromboembolic events. This image showed the origin of an imminent embolization.


Panel A

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Panel A
Panel A: Left Atrial Appendage.

Panel B

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Panel B
Panel B: Thromboembolic Complications.

Panel C

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Panel C
Panel C: Diagnosed as a Thrombus.

Panel D

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Panel D
Panel D: Epicardial Closure Device.