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After a presyncopal attack, echocardiography of a 79-year old man with atrial fibrillation and rheumatic mitral valve stenosis revealed a giant mobile ball thrombus transiently obstructing the mitral valve orifice, with another giant immobile thrombus filling the left atrial appendage (Supplementary Videos 1 and 2). Both thrombi, with dimensions of 40 × 30 and 60 × 30 mm, were removed successfully with the implantation of a prosthetic mitral valve (Figs 1 and 2). Supplementary material (Videos 1 and 2) is available at EJCTS online. Video 1: Echocardiographic apical four-chamber view of the free-floating giant ball thrombus transiently obstructing stenotic mitral valve orifice during diastole. Video 2: Echocardiographic parasternal short-axis view of the two thrombi in the left atrium.

Double giant thrombi in the left atrium in a patient with rheumatic mitral valve stenosis and atrial fibrillation