Fibrin strands are long, thin, mildly echogenic and mobile structures that are usually incidental findings after prosthetic heart valve surgery. They are seen by transesophageal echocardiography in 6% to 45% of patients. The formation of these benign strands may be the result of cardiac manipulation by surgical instrumentation. A case study of strand formation after aortic valve replacement is detailed. In any valvular lesion, differential diagnoses include thrombus and vegetation, and thus the clinical picture is important in diagnosing and managing valvular lesions. Although strands rarely embolize and are not associated with poor prognosis, their management and significance are items of debate.
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