A ping-pong ball in left atrium

Description

Rheumatic heart disease (RHD) is much prevalent in low/middle-income  country like India with the prevalence ranging from 0.2 to 1.1/1000 for RHD and from 0.0007 to 0.2/1000 for rheumatic fever.1 Factors that precipitate the formation of clot are atrial fibrillation (AF) rhythm, left atrial (LA) size, duration of symptoms, advanced age and severity of mitral stenosis (MS).2 The prevalence of LA clot in patients with MS is 26% in the AF group and 13.5% in the normal sinus rhythm group.3 The risk of thromboembolism is 9–14% of patients suffering from RHD.4 5 Anticoagulation (vitamin K antagonist or heparin) is indicated in patients with MS with (1) AF (paroxysmal, persistent or permanent) or (2) prior embolic event or (3) a LA thrombus.6

We present a case of a 30-year-old man, a known case of RHD who had balloon mitral valvotomy (BMV) 10 years...

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