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A 63-year-old man presented with a 12 month history of increasing dyspnoea and lethargy. Transthoracic echocardiography (Philips IE33, The Netherlands) demonstrated a 6.2 × 3.9 cm mobile hyperechoic lesion within a dilated left atrium (panel A). This lesion occupied most of the left atrium and could be seen to be prolapsing into the left ventricle in diastole (panel B and supplemental video; to view video footage visit the Heart website—http://www.heartjnl.com/supplemental …