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A 83-years-old woman underwent percutaneous balloon mitral valvuloplasty (PBMV) due to symptomatic rheumatic mitral stenosis. The transesophageal echocardiogram before PBMV revealed no atrial thrombus. PMBV was performed under fluoroscopic guidance. Following PBMV, an obstruction of the catheter lumen was detected. The transthoracic echocardiogram (TTE) showed a giant mass in the right atrium (Figure 1A), free mobile and eventually prolapsing into the right ventricle. The large thrombus was completely removed percutaneously (Figure 1B), confirmed by TTE (Figure 1C). Despite the use of unfractionated heparin, thrombus formation during PBMV can occur. Echocardiographic imaging is crucial for the detection of thrombus, which cannot be identified by fluoroscopy...
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