A 77-year-old man who had a left atrial free-floating ball thrombus without mitral valve disease was operated. His electrocardiogram showed atrial fibrillation. Transesophageal echocardiography showed free-floating mass in dilated left atrium and intact mitral valve. Transesophageal echocardiogram was also useful for intra-operative management. At the operation, the mass proved to be a free-floating ball thrombus in the left atrium and the intact mitral valve was confirmed. The thrombus was removed, but we could not wean the patient from extra-corporeal circulation due to intra-operative myocardial infarction. Autopsy showed left ventricular hypertrophy and the focus of acute myocardial infarction in lateral wall and posterior wall of left ventricle. Furthermore, large organized thrombi were found in aorta and right main pulmonary artery. It was suggested that the patient had abnormal coagulative system or fibrolytic system preoperatively.
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