Valvular heart disease, and in particular, rheumatic mitral stenosis is frequently associated with intra-cardiac thrombus. Moreover, almost all types of thrombus can be founded in the left atrium whereas the ball shaped thrombus remains very rare. The following case report describes a successful surgical management of an unusual case with a concomitant left atrial free-floating ball thrombus and mural one in a patient who has rheumatic mitral stenosis with atrial fibrillation. However, this patient did not present any cerebral or peripheral embolic events. Left atrial ball thrombus is relatively a rare case. Once the diagnosis was made, the surgical removal should be done immediately to avoid embolic complications and deterioration of hemodynamics.