Figure 1. Transthoracic echocardiography of FFLABT in patient's first admission.
Figure 2. Transesophageal echocardigraphy of FFLABT in patient's second admission.
Physical findings usually suggest mitral stenosis and, TTE and TEE are diagnostic tools [4]. Transesophogeal echocardio graphy is an useful tool for assessing the safest position for individuals with FFLABT. In the supine and right lateral decubitus positions, the thrombi recoil from and sometimes become entrapped within the mitral valve. In sitting and left lateral decubitus positions, the thrombi appear to be nearly fixed and does not contact with the mitral valve [5]. Murmur can increase or dissappeaer according to position of thrombus in the left atrium [6]. In our case, FFLABT was sitting on mitral valve orifice at the end of diastole and hurled into left atrial cavity by closure movement of mitral valve leaflets.
Sudden worsening of symptoms are probably due to closure of already stenosed mitral valve orifice by FFLABT that is avoiding passage of the blood from left atrium into left ventricle. Patients should undergo surgical treatment urgently.