Left ventricular free-floating ball thrombus complicating aortic valve stenosis

A 67-year-old man was referred for evaluation of near-syncopal attacks and left hemiparesis. Echocardiography revealed moderate to severe calcific aortic valve stenosis and a free-floating thrombus. Left ventricular (LV) systolic function was normal. No regional wall motion abnormality was detected in the left ventricle. On serial echocardiography, the thrombus began to fragment. Urgent surgery was commenced, during which the mass was seen to be a free-floating ball thrombus in the LV cavity, in addition to apical fibrin bands mimicking abnormal trabeculation. The thrombus was removed and aortic prosthetic valve replacement performed. No coagulation abnormalities were detected. The patient made a full recovery after surgery. Floating thrombus can embolize at any moment and require emergency treatment, notably because of a high mortality rate of systemic embolic events or acute hemodynamic decompensation caused by LV outflow tract obstruction. To the authors' knowledge, this is the first report of LV free-floating thrombus concomitant with isolated calcific aortic valve stenosis.