1
|
Motiduki N, Ushioda R, Yuzawa S, Miyatani K, Isa H, Setogawa Y, Ishidou K, Narita M, Suzuki F, Hirofuji A, Okubo R, Kunioka S, Tsutsui M, Ishikawa N, Hiroyuki K. A case of non-bacterial thrombotic endocarditis on the aortic valve following coronary angiography. J Surg Case Rep 2024; 2024:rjae212. [PMID: 38572290 PMCID: PMC10989293 DOI: 10.1093/jscr/rjae212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/15/2024] [Indexed: 04/05/2024] Open
Abstract
Nonbacterial thrombotic endocarditis (NBTE) on the aortic valve involves fibrin and platelet aggregate formation, potentially leading to embolic events. We present a case of NBTE on the aortic valve following coronary angiography (CAG) in a 54-year-old man with multiple comorbidities. Surgical thrombectomy was performed owing to acute cerebral infarcts. This case highlights the significance of considering that mechanical trauma from catheterization during CAG can trigger thrombus formation.
Collapse
Affiliation(s)
- Nobuhiro Motiduki
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Ryohei Ushioda
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Sayaka Yuzawa
- Department of Diagnostic Pathology, Asahikawa Medical University Hospital, Midorigaoka 1-1-1, Asahikawa 078-8510, Japan
| | - Kazuki Miyatani
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Hideki Isa
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Yuki Setogawa
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Kohei Ishidou
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Masahiko Narita
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Fumitaka Suzuki
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Aina Hirofuji
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Ryo Okubo
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Shingo Kunioka
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Masahiro Tsutsui
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Natsuya Ishikawa
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Kamiya Hiroyuki
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| |
Collapse
|
2
|
Velayutham R, Parale C, Kumar R, Anantharaj A. Coronary cusp thrombosis: a rare cause of myocardial infarction. J Echocardiogr 2023; 21:131-133. [PMID: 35412197 DOI: 10.1007/s12574-022-00573-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/16/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Ramanathan Velayutham
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, JIPMER, Campus Road, Dhanvantari Nagar, Puducherry, 605006, India
| | - Chinmay Parale
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, JIPMER, Campus Road, Dhanvantari Nagar, Puducherry, 605006, India
| | - Ritesh Kumar
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, JIPMER, Campus Road, Dhanvantari Nagar, Puducherry, 605006, India
| | - Avinash Anantharaj
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, JIPMER, Campus Road, Dhanvantari Nagar, Puducherry, 605006, India.
| |
Collapse
|
3
|
Farouji I, Chan KH, Battah A, Abed H, DaCosta T, Correia J, Suleiman A. A rare case of marijuana associated with ascending aorta thrombosis complicated with stroke and bilateral renal infarcts. Radiol Case Rep 2022; 17:119-123. [PMID: 34804314 PMCID: PMC8581276 DOI: 10.1016/j.radcr.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/03/2021] [Accepted: 10/06/2021] [Indexed: 01/24/2023] Open
Abstract
Ascending aortic is an uncommon site for arterial thrombosis and ascending aortic thrombosis is a very rare phenomenon with a high fatality rate. Marijuana is the most commonly used psychoactive drug in the United States and a few cases have been reported on the association of marijuana with vascular thromboembolism. However, the pathophysiology and exact mechanism are still not well studied. Herein, we present a case of a 44-year-old female with active marijuana use presented with ascending aortic thrombus associated with acute arterial occlusion of the right vertebral artery and bilateral renal artery. The unique part of this case is that the patient did not have the classical risk factors for vascular thromboembolic disease. The only risk factor was marijuana smoking. To our best knowledge, this is one of the unique cases of marijuana-associated with ascending aorta thrombosis.
Collapse
Affiliation(s)
- Iyad Farouji
- Department of Medical Education, Saint Michael's Medical Center, New York Medical College, Newark, USA
| | - Kok Hoe Chan
- Department of Hematology and Oncology, University of Texas, Houston, USA
| | - Arwa Battah
- Department of Medical Education, Saint Michael's Medical Center, New York Medical College, Newark, USA
| | - Hossam Abed
- Department of Medical Education, Saint Michael's Medical Center, New York Medical College, Newark, USA
| | - Theodore DaCosta
- Department of Medical Education, Saint Michael's Medical Center, New York Medical College, Newark, USA
- Department of Gastroenterology, Saint Michael's Medical Center, New York Medical College, Newark, USA
| | - Joaquim Correia
- Department of Medical Education, Saint Michael's Medical Center, New York Medical College, Newark, USA
- Department of Cardiology, Saint Michael's Medical Center, New York Medical College, Newark, USA
| | - Addi Suleiman
- Department of Medical Education, Saint Michael's Medical Center, New York Medical College, Newark, USA
- Department of Cardiology, Saint Michael's Medical Center, New York Medical College, Newark, USA
| |
Collapse
|
4
|
Balfour P, Rossi A, Aktuerk D, Anderson S. An Unusual Thrombus in a Strange Location-A Case Report of an Aortic Valve Thrombus Forming While Heparinized for Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2021; 36:2553-2557. [PMID: 34776349 DOI: 10.1053/j.jvca.2021.09.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/24/2021] [Accepted: 09/29/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Paul Balfour
- St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Alessia Rossi
- St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Dincer Aktuerk
- St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Stuart Anderson
- St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
| |
Collapse
|
5
|
Gómez JLZ, Gómez AG. Aortic Valve Thrombosis: Be Prepared for the Unusual. J Am Coll Cardiol 2021; 78:825-826. [PMID: 34412816 DOI: 10.1016/j.jacc.2021.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 11/15/2022]
|
6
|
Alajaji W, Hornick JM, Malek E, Klein AL. The Characteristics and Outcomes of Native Aortic Valve Thrombosis: A Systematic Review. J Am Coll Cardiol 2021; 78:811-824. [PMID: 34412815 DOI: 10.1016/j.jacc.2021.06.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/09/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is a lack of knowledge in the current medical literature about native aortic valve thrombosis. OBJECTIVES The aim of this systematic review was to summarize the characteristics, presentations, underlying etiologies, and outcomes of native aortic valve thrombosis and to present a meta-analysis of the best available data. METHODS The authors performed a literature search, identified published cases of patients with native aortic valve thrombosis, and pooled the data in this meta-analysis. The statistical analysis included calculations of the prevalence of the various presentations, underlying etiologies, aortic cusp involvement, as well as choices of diagnostic testing. They calculated the sensitivities of the various diagnostic testing as well as in-hospital mortality event rates and the univariate ORs of the risk factors for poor outcomes. RESULTS The search strategy and screening process yielded 74 cases of native aortic valve thrombosis, which are included in this meta-analysis. The data revealed that the most common presentation was myocardial infarction in 36%, and the most common underlying etiology was hypercoagulable state in 30%. In-hospital clinical deterioration after presentation including recurrent embolism occurred in ∼38%, and in-hospital mortality rate was ∼20%. CONCLUSIONS Native aortic valve thrombosis is clinically relevant, especially in patients presenting with embolic events. Awareness about native aortic valve or root thrombosis as well as its underlying etiologies, diagnostic work-up, and management is essential, because this condition can be associated with poor outcomes.
Collapse
Affiliation(s)
- Wissam Alajaji
- Summa Health, Heart and Vascular Institute, Akron, Ohio, USA
| | - John M Hornick
- Summa Health, Heart and Vascular Institute, Akron, Ohio, USA
| | - Eliane Malek
- University Hospitals Rainbow Babies and Children's Hospital and School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Allan L Klein
- Cleveland Clinic, Heart Vascular and Thoracic Institute, Cleveland, Ohio, USA.
| |
Collapse
|
7
|
Takafuji H, Nakama T, Asano K, Obunai K. Acute coronary syndrome of the left main coronary artery caused by a huge floating thrombus in the ascending aorta: a case report of intravascular ultrasound effectiveness. Eur Heart J Case Rep 2021; 5:ytab279. [PMID: 34423244 PMCID: PMC8374986 DOI: 10.1093/ehjcr/ytab279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/23/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022]
Abstract
Background Left main coronary artery (LMCA)–acute coronary syndrome (ACS) is a rare complication of a floating thrombus in the ascending aorta. However, diagnosing the aetiology of LMCA–ACS during an emergency situation is challenging. We present a rare case of LMCA–ACS caused by a large thrombus in the ascending aorta, confirmed by intravascular ultrasound (IVUS). Case summary A 90-year-old woman presented to the emergency department complaining of chest pain and syncope. On admission, her electrocardiogram showed normal sinus rhythm and a complete right bundle branch block with significant ST depression in the V3–V6 leads; hence, ACS was suspected. The first emergency angiogram of the left coronary artery showed filling defect in the proximal ascending aorta. IVUS revealed a large thrombus in the ascending aorta. The thrombus extended from the ascending aorta to the proximal left anterior descending coronary artery. IVUS confirmed that there was no dissection of the coronary artery or the proximal ascending aorta. Based on the IVUS findings, this case was diagnosed as ACS of the LMCA caused by a floating thrombus in the ascending aorta. Discussion This rare case of LMCA–ACS caused by a thrombus in the ascending aorta was confirmed by IVUS, which can be a useful imaging tool for diagnosing morphological abnormalities during emergencies.
Collapse
Affiliation(s)
- Hiroya Takafuji
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba 279-0001, Japan
| | - Tatsuya Nakama
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba 279-0001, Japan
| | - Kazuhiro Asano
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba 279-0001, Japan
| | - Kotaro Obunai
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba 279-0001, Japan
| |
Collapse
|
8
|
Chen YY, Yen HT, Wu CC, Huang KR, Sheu JJ, Lee FY. Aortic Thrombus in a Nonaneurysmal Ascending Aorta. Ann Vasc Surg 2020; 72:617-626. [PMID: 33249131 DOI: 10.1016/j.avsg.2020.10.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/13/2020] [Accepted: 10/18/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Ascending aortic thrombus (AAT) in a nonaneurysmal aorta is an extremely rare event and has potentially catastrophic complications, with a life-threatening risk of myocardial infarction and cerebral embolization. This systematic review aims to elucidate the clinical manifestations and to compare the outcomes of anticoagulation therapy versus open aortic surgery for AAT. METHODS The MEDLINE/PubMed databases were extensively searched between 1995 and 2019. All relevant publications on AAT in adults were reviewed, and individual patient data were pooled in this meta-analysis. The primary outcome was AAT resolution. The adverse outcome variables were recurrent arterial embolic events, complications related to open aortic surgery, and mortality during the study period. Chi-squared test and logistic regression analysis were used to compare groups and identify any predictors of mortality. RESULTS Overall, 107 patients from 101 articles were included, of whom 29 patients who received anticoagulation therapy and 59 who underwent open aortic surgery were included in the outcome analysis. Among 29 patients treated with initial anticoagulation therapy, the persistence of AAT was observed in 11 patients (38%) and recurrent arterial embolization was developed in 6 patients (21%). All 11 patients in the anticoagulation group underwent secondary aortic surgery for the persistence of AAT with uneventful postoperative course. Compared with patients treated with primary aortic surgery, patients treated with initial anticoagulation therapy had higher risk of recurrent embolization (P = 0.002). No significant difference existed in the mortality rates between the groups (P = 0.106). Hemodynamic instability was an independent predictor of mortality (P = 0.008). CONCLUSIONS Anticoagulation therapy and open aortic surgery for AAT show similar results; however, open aortic surgery reliably removes AAT and reduces the risk of recurrent embolization compared with anticoagulation therapy. Furthermore, the preoperative hemodynamic status significantly influences the clinical outcome and is a strong predictor of prognosis.
Collapse
Affiliation(s)
- Yen-Yu Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Hsu-Ting Yen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Chen Wu
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kwan-Ru Huang
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jiunn-Jye Sheu
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fan-Yen Lee
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| |
Collapse
|
9
|
Ravishankar M, Ghergherehchi A, Liu J, Jimenez E, Khalid U. Large Sinus of Valsalva Aneurysm Complicated by Thrombus Formation. Methodist Debakey Cardiovasc J 2020; 16:e8-e10. [PMID: 33133369 DOI: 10.14797/mdcj-16-3-e8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Sinus of Valsalva aneurysm (SOVA) is an unusual cardiac anomaly that is potentially fatal with rupture. It is often asymptomatic but has various presentations. We describe a case of a 67-year-old male who presented with atypical chest pain. Transthoracic echocardiogram and cardiac computed tomography scan confirmed a large SOVA complicated by thrombus formation and compression of the left atrium and left ventricular outflow tract. The patient successfully underwent a Bentall procedure-surgical aortic aneurysm repair with mechanical aortic valve conduit. We discuss several clinical decision-making branch points to highlight the complexity of managing this condition. Even in asymptomatic or minimally symptomatic patients with SOVA, surgery may be indicated if the aneurysm meets the criteria for size or has thrombus formation or compressive effects.
Collapse
Affiliation(s)
- Milan Ravishankar
- MICHAEL E. DEBAKEY VA MEDICAL CENTER, BAYLOR COLLEGE OF MEDICINE, HOUSTON, TEXAS
| | - Ali Ghergherehchi
- MICHAEL E. DEBAKEY VA MEDICAL CENTER, BAYLOR COLLEGE OF MEDICINE, HOUSTON, TEXAS
| | - Jing Liu
- MICHAEL E. DEBAKEY VA MEDICAL CENTER, BAYLOR COLLEGE OF MEDICINE, HOUSTON, TEXAS
| | - Ernesto Jimenez
- MICHAEL E. DEBAKEY VA MEDICAL CENTER, BAYLOR COLLEGE OF MEDICINE, HOUSTON, TEXAS
| | - Umair Khalid
- MICHAEL E. DEBAKEY VA MEDICAL CENTER, BAYLOR COLLEGE OF MEDICINE, HOUSTON, TEXAS
| |
Collapse
|
10
|
Cai XJ, Tan TN, Chai SC, Liew CJY, Liew BWM, Lim BY. “Catch Me If You Can”. JACC Case Rep 2020; 2:1974-1978. [PMID: 34317092 PMCID: PMC8299257 DOI: 10.1016/j.jaccas.2020.07.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/31/2020] [Indexed: 10/26/2022]
|
11
|
Khosravi A, Kermani-Alghoraishi M, Pourmoghadas M. Ascending Aorta Thrombose: A Rare Cause of Simultaneous Acute Myocardial Infarction and Upper Limb Ischemia. ACTA CARDIOLOGICA SINICA 2020; 36:382-385. [PMID: 32675931 DOI: 10.6515/acs.202007_36(4).20200420a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Alireza Khosravi
- Hypertention Research Center.,Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Kermani-Alghoraishi
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Pourmoghadas
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
12
|
Lim SJ, Koo HJ, Jung SC, Kang DY, Ahn JM, Park DW, Park SJ, Yang DH, Kang JW. Sinus of Valsalva Thrombosis Detected on Computed Tomography after Transcatheter Aortic Valve Replacement. Korean Circ J 2020; 50:572-582. [PMID: 32281322 PMCID: PMC7321751 DOI: 10.4070/kcj.2019.0385] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/06/2020] [Accepted: 03/03/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Leaflet thrombosis after transcatheter aortic valve replacement (TAVR) has been reported recently, whereas thrombus formation in sinus of Valsalva has yet to be fully evaluated. This study describes clinical and cardiac computed tomography (CT) findings of patients with sinus of Valsalva thrombosis. METHODS Between March 2011 and Aug 2019, 192 patients underwent cardiac CT after TAVR. After a retrospective review of CT images, 9 patients (82 years, male:female=2:7) who had sinus of Valsalva thrombosis identified by cardiac CT were selected for this study. Patient demographics, interval between TAVR and cardiac CT scan, location and CT attenuation of sinus of Valsalva thrombosis, and presence of concurrent leaflet thrombosis were evaluated. RESULTS The median interval between TAVR and cardiac CT was 11 days. Sinus of Valsalva thrombosis was frequently detected in the non-coronary sinus (89%, 8/9), and predominantly located in the bottom of the sinus extending upward towards the sinotubular junction. Three patients had concomitant leaflet thrombosis, and 3 patients had subclinical embolic stroke noted on brain magnetic resonance imaging. All patients had been prescribed aspirin and clopidogrel after TAVR for at least 6 months without anticoagulants. CONCLUSIONS Cardiac CT after TAVR can detect sinus of Valsalva thrombosis, and attention should be paid to this potential source of subsequent systemic embolization.
Collapse
Affiliation(s)
- Su Jin Lim
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| |
Collapse
|
13
|
Coronary Embolism and Myocardial Infarction: A Scoping Study. AMERICAN JOURNAL OF MEDICAL CASE REPORTS 2020; 8:31-43. [PMID: 32775621 PMCID: PMC7410523 DOI: 10.12691/ajmcr-8-2-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Coronary embolism is a cause of acute myocardial infarction (AMI)in which obstructive foci enter the coronary circulation, block normal blood flow and precipitate ischemia. Precise studies focusing on patient population affected, pathophysiological mechanisms, and treatment strategies are scanty, in spite of a reported prevalence estimated at 2.9%. As the understanding of myocardial infarction without evidence of coronary artery disease continues to grow, an in-depth review of this previously seldomly reported subtype of coronary ischemia was in order. Patients suffering coronary embolism are 15 to 20 years younger than traditional AMI patients with a slight predominance towards male sex, which resembles the gender data of the populations affected by non-traditional myocardial infarction in published reports. While the expected prevalence rate of cardiovascular disease risk factors such as hypertension and hyperlipidemia are present, this population also has a relatively high prevalence of atrial fibrillation and valve pathology, especially endocarditis. Initial presentation is indistinguishable from other causes of myocardial infarction however fever is commonly present, when endocarditis with valvular involvement is the primary cause of the coronary embolism. Mechanical thrombectomy is the mainstay of treatment, followed by percutaneous coronary intervention. Mortality is the highest in patients who do not receive targeted treatment for the coronary embolism, particularly if only antimicrobial agents or anticoagulation without thrombolytic agents are employed. The unique features of coronary embolism highlighted in this historical study justify further examination in contemporary patient populations.
Collapse
|
14
|
Beekman-van Solkema G, Schoots MH, Pundziute-Do Prado G. A rare cause of acute ST-elevation myocardial infarction: case report of native aortic valve thrombosis. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 4:1-4. [PMID: 32128505 PMCID: PMC7047074 DOI: 10.1093/ehjcr/ytz232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/20/2019] [Accepted: 12/04/2019] [Indexed: 11/14/2022]
Abstract
Background One to 13% of all patients with the clinical diagnosis of an acute coronary syndrome (ACS) show no evidence of significant obstructive coronary artery disease on angiography. Less common causes should be considered in those situations. A very rare cause of ACS is native aortic valve thrombosis. Case summary A 69-year-old previously healthy woman presented with acute chest pain. The electrocardiogram showed an anterolateral ST-elevation myocardial infarction (STEMI). She was immediately transferred for primary percutaneous coronary intervention. Shortly after arriving in hospital her condition deteriorated, with development of cardiogenic shock necessitating cardiopulmonary resuscitation. A coronary angiogram was performed during resuscitation that did not reveal any obstructive coronary artery disease. Echocardiography showed no pericardial effusion, no significant left-sided valve pathology, no signs of an aortic dissection or pulmonary embolism. She died of cardiogenic shock of unknown cause. Permission for autopsy was obtained. Pathologic examination revealed a large anterolateral myocardial infarction caused by a mass attached to the bottom of the left coronary cusp of the native aortic valve, which was large enough to occlude the ostium of the left main coronary artery. Microscopic analysis showed a thrombus of unknown origin. The aortic valve itself showed no signs of pathology. Discussion An ST-elevation myocardial infarction due to native aortic valve thrombosis is a rare condition, especially when there are no significant valvular abnormalities. This case demonstrates that thrombosis can develop in an apparently healthy middle-aged woman without any history of thrombotic disease.
Collapse
Affiliation(s)
- Gerrie Beekman-van Solkema
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - M H Schoots
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - G Pundziute-Do Prado
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| |
Collapse
|
15
|
Parato VM, Cardinali A, Scarano M. Aortic Regurgitation as a Risk Factor for Coronary Embolization from Complex Atheromatous Aortic Plaques: A Clinical Case. J Cardiovasc Echogr 2019; 29:58-61. [PMID: 31392120 PMCID: PMC6657464 DOI: 10.4103/jcecho.jcecho_72_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Patients with mobile aortic arch atheroma and severe aortic regurgitation may be at higher risk of systemic embolism. We report the case of a 68-year-old male patient with complex aortic arch plaque with superimposed thrombus, in which an acute inferior ST-elevation myocardial infarction occurred. In the reported case, coronary embolism may have been caused by flaked aortic plaque and/or superimposed thrombus, which was possibly carried by aortic regurgitation flow. It is a very rare mechanism by which a coronary embolism is possible from an aortic complex plaque.
Collapse
Affiliation(s)
- Vito Maurizio Parato
- Department of Emergency, Cardiology Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - Alfredo Cardinali
- Department of Emergency, Cardiology Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - Michele Scarano
- Department of Emergency, Cardiology Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy
| |
Collapse
|
16
|
Lacey MJ, Raza S, Rehman H, Puri R, Bhatt DL, Kalra A. Coronary Embolism: A Systematic Review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:367-374. [PMID: 31178350 DOI: 10.1016/j.carrev.2019.05.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 04/30/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Coronary embolism is a rare and potentially fatal phenomenon that occurs primarily in patients with valvular heart disease and atrial fibrillation. There is a lack of consensus regarding the diagnosis, treatment, and management of coronary embolism, leaving management at the discretion of the treating physician. Through this review, we aim to establish a better understanding of coronary embolism, and to identify treatment options - invasive and non-invasive - that may be used to manage coronary embolism. METHODS AND RESULTS Our systematic review included 147 documented cases of coronary embolism from case reports and case series. The average age of our population was 54.2 ± 17.6 years. The most common causes of coronary embolism included infective endocarditis (22.4%), atrial fibrillation (17.0%), and prosthetic heart valve thrombosis (16.3%). Initial presentation was indistinguishable from an acute coronary syndrome (ACS) due to coronary atherosclerosis, and the diagnosis required a high level of suspicion and evaluation with angiography. Treatment strategies included, but were not limited to, thrombectomy, thrombolysis, balloon angioplasty and stent placement. Myocardial dysfunction on echocardiography was observed in over 80% of patients following coronary embolism. "Good outcomes" were reported in 68.7% of case reports and case series, with a mortality rate of 12.9%. CONCLUSION Coronary embolism is an under-recognized etiology of myocardial infarction with the potential for significant morbidity and mortality. To improve outcomes, physicians should strive for early diagnosis and intervention based on the underlying etiology. Thrombectomy may be considered with the goal of rapid restoration of coronary flow.
Collapse
Affiliation(s)
- Matthew J Lacey
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Sajjad Raza
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Hasan Rehman
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, United States
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, United States
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States.
| |
Collapse
|
17
|
Rácz B, Linhart A, Bělohlávek J, Mikulenka V, Šachl R, Vařejka P. Rare cause of recurrent systemic embolism in a middle-aged woman with undiagnosed lung A-V malformation. COR ET VASA 2019. [DOI: 10.1016/j.crvasa.2018.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
18
|
Abubakar H, Ahmed AS, Subahi A, Yassin AS. Thrombus in the Right Coronary Sinus of Valsalva Originating From the Left Atrial Appendage Causing Embolic Inferior Wall Myocardial Infarction. J Investig Med High Impact Case Rep 2018; 6:2324709618792023. [PMID: 30057924 PMCID: PMC6058415 DOI: 10.1177/2324709618792023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/14/2018] [Accepted: 06/24/2018] [Indexed: 12/02/2022] Open
Abstract
Acute myocardial infarction (MI) is commonly a result of coronary atherosclerotic plaque rupture and superimposed thrombus formation. Nevertheless, uncommon causes of MI including embolism from aortic root and ascending aorta mural thrombi must be considered when coronary atherosclerotic disease is not evident. We report a case of a 84-year-old woman who presented with an inferior ST-segment elevation MI. Initial attempts to engage the right coronary artery (RCA) were unsuccessful. Aortic angiography revealed evidence of the left coronary artery ostium with absence of the right coronary ostium or RCA. Probing with a coronary wire where the RCA ostium was presumed to be located yielded resolution of the ST-segment elevation. The RCA was then easily engaged using a guide catheter, and angiographic evaluation showed a smooth vessel with no evidence of coronary artery disease except for abrupt termination of the distal PL2 branch. Contrast-enhanced computed tomography revealed an aortic root thrombus extending into the right coronary sinus of Valsalva and a thrombus in the left atrial appendage. The case reveals RCA embolism from an aortic root thrombus likely originating from the left trial appendage. A conservative approach to treatment with anticoagulation was pursued that resulted in full recovery. A review of the literature revealed that the etiology of aortic root thrombi is proposed to be multifactorial. Prospective randomized studies are needed to demonstrate the best treatment approach, although this appears to be impracticable given the rarity of the disease.
Collapse
|
19
|
Joković V, Končar I, Knežević D, Sretenović S, Stamenković D, Vulić D. Free floating thrombus in the non-atherosclerotic, non-aneurysmal ascending thoracic aorta: A rare entity. ACTA ACUST UNITED AC 2017. [DOI: 10.5937/mckg51-16433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
20
|
Velagapudi P, Turagam MK, Dohrmann M. Occam's razor or Hickam's dictum: a rare case of pulmonary embolism after myocardial infarction and stroke from aortic arch thrombi. QJM 2015; 108:971-2. [PMID: 25956390 DOI: 10.1093/qjmed/hcv084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P Velagapudi
- From the Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - M K Turagam
- From the Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - M Dohrmann
- From the Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| |
Collapse
|
21
|
Jeon W, Lee SJ, Park SH, Lee SW, Shin WY, Jin DK. Acute myocardial infarction caused by a floating thrombus in the proximal ascending aorta. Korean J Intern Med 2015; 30:921-4. [PMID: 26552469 PMCID: PMC4642023 DOI: 10.3904/kjim.2015.30.6.921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 11/03/2014] [Accepted: 12/09/2014] [Indexed: 12/02/2022] Open
Affiliation(s)
| | - Seung-Jin Lee
- Correspondence to Seung Jin Lee, M.D. Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea Tel: +82-41-570-3896 Fax: +82-41-574-5762 E-mail:
| | | | | | | | | |
Collapse
|
22
|
Saxena R, Kumar MV, Kumar S, Gharde P, Talwar S, Choudhary SK. Thrombus in the Proximal Aorta: Cardiopulmonary Bypass Strategy and Surgical Management. Ann Thorac Surg 2015; 100:311-3. [DOI: 10.1016/j.athoracsur.2014.07.078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 07/01/2014] [Accepted: 07/21/2014] [Indexed: 10/23/2022]
|
23
|
Saygi S, Alioglu E, Karabulut MN, Turk UO, Kirilmaz B, Tuzun N, Sahin F, Kosova B, Tengiz I. A Floating Thrombus in Sinus of Valsalva Complicated with Cardiogenic Shock in a Patient with Plasminogen Activator Inhibitor 1 4G/5G Polymorphism. Echocardiography 2011; 28:E164-7. [DOI: 10.1111/j.1540-8175.2011.01432.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
24
|
Sawada T, Shimokawa T. Giant thrombus in the ascending aorta that caused systemic embolism. Interact Cardiovasc Thorac Surg 2011; 12:1048-50. [PMID: 21422157 DOI: 10.1510/icvts.2011.266445] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Although an ascending aortic thrombus is a rare finding, it may cause major embolic complications. We report a case of a 58-year-old male who suffered from cerebral and left renal infarctions due to emboli from a giant thrombus in the ascending aorta. The thrombus was demonstrated by computed tomography and transesophageal echocardiography. Ten days after the initiation of anticoagulation therapy, surgery was performed. After a median sternotomy was performed and cardiopulmonary bypass was initiated, the ascending aorta was replaced with a synthetic graft under hypothermic circulatory arrest and retrograde cerebral perfusion. The excised specimen revealed a 3.5×3.0×3.0-cm pedunculated thrombus. The patient's postoperative recovery was uneventful, and there was no recurrence of aortic thrombosis during one year of postoperative follow-up. The patient had no coagulation disorders, and the etiology of this giant thrombus remains unclear. We believe that initial treatment for an ascending aortic thrombus should be emergency surgery before it leads to major embolic events. However, the treatment strategy for a thrombus causing cerebral infarction is sometimes difficult to develop.
Collapse
Affiliation(s)
- Takahiro Sawada
- Department of Cardiovascular Surgery, Teikyo University Hospital, Itabashi-Ku, Tokyo 173-8605, Japan.
| | | |
Collapse
|
25
|
LaPorte F, Selton-Suty C, Bonnemains L, Groben L. Acute Myocardial Infarction Caused by Sinus of Valsalva Aneurysm. Echocardiography 2010; 28:E19-20. [DOI: 10.1111/j.1540-8175.2010.01281.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
26
|
Chlapoutakis GN, Kafkas NV, Katsanos SM, Kiriakou LG, Floros GV, Mpampalis DK. Acute myocardial infarction and transient ischemic attack in a patient with lone atrial fibrillation and normal coronary arteries. Int J Cardiol 2010; 139:e1-4. [DOI: 10.1016/j.ijcard.2008.06.085] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Accepted: 06/28/2008] [Indexed: 11/26/2022]
|
27
|
Park SJ, Park JH, Rim SJ, Ahn MS, Lee JH, Choi SW, Jeong JO, Seong IW. Peripheral arterial embolism caused by a floating thrombus in the right coronary sinus of Valsalva. Int J Cardiol 2009; 131:433-4. [DOI: 10.1016/j.ijcard.2007.07.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Revised: 07/02/2007] [Accepted: 07/07/2007] [Indexed: 11/24/2022]
|
28
|
Knoess M, Otto M, Kracht T, Neis P. Two consecutive fatal cases of acute myocardial infarction caused by free floating thrombus in the ascending aorta and review of literature. Forensic Sci Int 2007; 171:78-83. [PMID: 17010548 DOI: 10.1016/j.forsciint.2006.08.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Revised: 07/21/2006] [Accepted: 08/30/2006] [Indexed: 11/25/2022]
Abstract
Free floating thrombus in the ascending aorta is an uncommon source of acute myocardial infarction. We report on two cases of young women who died of acute myocardial infarction caused by a free floating thrombus in the sinus of Valsalva obstructing the coronary arteries' ostia. The first case reports on a 30-year-old pregnant woman who anamnestically had episodes with short loss of consciousness and weakness. The second case presents a 37-year-old woman suffering from multiple sclerosis with no previous history of thrombotic events. The review of literature revealed a predominance of women (eight females and three males). Interestingly, the coronary arteries bear no preference concerning the right (RCA) or left coronary artery (LCA) being more often occluded by a free floating thrombus. Especially, younger women (mean age 45.5 years, range 30-59 years) with no history of cardiac symptoms and without atherosclerotic changes seem to be predispositioned. The hypothesis that thrombus formation in cases without plaque disruption may depend on an endothelial erosion which seems to be more common in younger women and promoted by a hyperthrombogenic state is supported by our two cases. A comprehensive literature search revealed, that these are the first two reports on a free floating thrombus being the cause of fatal acute myocardial infarction in a pregnant woman, respectively, a woman suffering from multiple sclerosis.
Collapse
Affiliation(s)
- M Knoess
- Institute of Clinical Pathology, Moltkestrasse 32, 54292 Trier, Germany.
| | | | | | | |
Collapse
|
29
|
Ennezat PV, Sudre A, Pouwels S, Aubert JM, Cordova H, Samaille PP, Gonin X, Sautière K, Bauchart JJ, Auffray JL, Van Belle E, Lablanche JM, Goldstein P, Asseman P. Acute coronary syndromes associated with thrombus in the sinus of valsalva and normal coronary arteriography: the pivotal role of transesophageal echocardiography in the intensive care unit. Mayo Clin Proc 2006; 81:399-402. [PMID: 16529145 DOI: 10.4065/81.3.399] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We describe 4 patients with thrombus in nonaneurysmal sinus of Valsalva. The diagnosis was made with transesophageal echocardiography performed in the Intensive care unit, in the setting of acute coronary syndromes. Coronary arterlography showed normal coronary arteries in each patient. In 3 patients, conservative medical therapy resulted in full recovery. Two patients had previously undergone aortic valve surgery.
Collapse
Affiliation(s)
- Pmerre V Ennezat
- Intensive Care Unit, Cardiology Hospital, Bd Pr J. Leclercq, 59000 Lille, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
A 72-year-old man was admitted to our hospital with a renal infarction. On admission, computed tomography (CT) of the abdomen revealed total occlusion of the right renal artery, which was found to be recanalized with residual thrombus 7 days later. Transesophageal echocardiography and chest CT demonstrated crescent-shaped thrombus in the non-coronary sinus of Valsalva without evidence of aneurysm. After coumadin treatment the patient did not experience recurrent episodes of systemic embolization. Five months after the initiation of anticoagulation, transesophageal echocardiography and chest CT demonstrated disappearance of the thrombus. This is a rare case of renal infarction caused by a thrombus in the non-coronary sinus of Valsalva without aneurysm.
Collapse
Affiliation(s)
- Akio Nakata
- Division of Internal Medicine, Kurobe Municipal Hospital, Kurobe, Toyama
| | | | | | | |
Collapse
|
31
|
Wolfsohn AL, So DYF, Chan K, Burwash I, Hendry P, Veinot JP, Labinaz M. Thrombus of the ascending aorta. Cardiovasc Pathol 2005; 14:214-8. [PMID: 16009320 DOI: 10.1016/j.carpath.2005.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2004] [Revised: 02/16/2005] [Accepted: 02/24/2005] [Indexed: 11/21/2022] Open
Abstract
We present two cases of a thrombus in the ascending aorta causing an acute myocardial infarction (AMI) and review the 10 other cases previously reported in the literature. This life-threatening condition appears to be more common in female smokers in their fifth decade. Suspicion should be raised in individuals at low risk for atherosclerotic disease with coronary angiographic findings not in keeping with the clinical presentation. The diagnosis may be obtained by transesophageal echocardiography, and we generally recommend surgical thrombectomy.
Collapse
Affiliation(s)
- Allan L Wolfsohn
- Division of Anatomical Pathology, Ottawa Hospital, Ottawa, ON, Canada, K1Y 4E9.
| | | | | | | | | | | | | |
Collapse
|