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A 45-year-old man with a history of constrictive pericarditis underwent an uncomplicated pericardiectomy. Perioperative transesophageal echocardiography did not reveal any intraventricular masses. Three days after discharge, he presented with fever and changes in mental status. Transesophageal echocardiography showed the left atrium at the top of the image, the left ventricular apex at the bottom of the image, and the left ventricular outflow tract, the aortic valve, and the proximal ascending aorta as they emerged from the left ventricle. A left ventricular thrombus (arrow in video) originated from the apex of the anteroseptal wall and moved freely during the cardiac cycle. During diastole the distal portion of the thrombus was approximately 1 cm proximal to the aortic-valve annulus. The thrombus was propelled toward the aortic valve during early systole and traversed the aortic valve during late systole. Although the thrombus was surgically removed, the patient died from a stroke shortly thereafter.
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