A 62-year-old-woman with no previous medical history was admitted to a local hospital after she was fortuitously diagnosed with atrial fibrillation. TTE revealed a severe mitral stenosis (valve area 1.2 cm 2 ; mean gradient 6 mmHg) with a severely enlarged left atrium and a huge LA thrombus, which was confirmed with transoesophageal echocardiography (maximal length 44 mm; Figs. 1A–C ). Five days after the introduction of anticoagulation therapy with intravenous heparin and a vitamin K antagonist (international normalized ratio 2.7), the patient had an embolic stroke ( Fig. 1 D; computed axial tomography) from which she mostly recovered except for facial paralysis and aphasia. The patient was referred to our hospital and underwent emergency (within 24 hours) mitral valve replacement using bioprosthesis in association with LA thrombus ablation and LA appendage exclusion ( Figs. 1E, F ) on day 2 of the stroke. The postoperative course was uneventful and the patient was discharged on day 7.
