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Mitsuishi A, Miura Y, Furukawa A, Yoshida K, Fukunaga Y. Surgical removal of multiple left ventricular thrombi with video-assisted cardioscopy: a case report. Eur Heart J Case Rep 2023; 7:ytad519. [PMID: 37942353 PMCID: PMC10629687 DOI: 10.1093/ehjcr/ytad519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 11/10/2023]
Abstract
Background Left ventricular (LV) thrombus is a lethal complication of coronary artery disease that can lead to embolization and sudden death. There is no clear consensus on the optimal treatment for LV thrombi. There is a paucity of case series about surgical excision of LV thrombus in patients with coronary vessel disease. For that, there is insufficient evidence to support surgical excision of LV thrombus and recommend the optimal timing of this procedure. Case summary We report a case of a 52-year-old man with a history of percutaneous catheter intervention for mid-right coronary artery lesion 3 years ago. He presented with two-vessel coronary artery disease with three LV thrombi. The thrombi were mobile and protuberant. We performed coronary artery bypass grafting in both vessels and LV thrombectomy with video-assisted cardioscopy. Discussion Mobile or protuberant thrombus is the most important risk factor for embolization of LV thrombus. On the other hand, LV thrombus size rarely appears in studies as a risk factor for embolization, and when it does, it is a lesser risk factor. There are no case reports describing simultaneous formation of three LV thrombi after myocardial infarction, and it is not known if the risk of embolism is high in such cases. Our patient had very fragile thrombi, and thrombectomy was performed along with coronary artery bypass grafting due to the high risk of embolism.
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Affiliation(s)
- Atsuyuki Mitsuishi
- Department of Cardiovascular Surgery, Kochi Medical School Hospital, 185-1, Kohasu, Okohcho, Nankoku-shi, Kochi Prefecture 783-8505, Japan
| | - Yujiro Miura
- Department of Cardiovascular Surgery, Kochi Medical School Hospital, 185-1, Kohasu, Okohcho, Nankoku-shi, Kochi Prefecture 783-8505, Japan
| | - Atsuko Furukawa
- Department of Cardiology, Hosogi Hospital, 35, Daizenjicho, Kochi-shi, Kochi Prefecture 780-8535, Japan
| | - Keisuke Yoshida
- Department of Cardiovascular Surgery, Kochi Medical School Hospital, 185-1, Kohasu, Okohcho, Nankoku-shi, Kochi Prefecture 783-8505, Japan
| | - Yukiko Fukunaga
- Department of Surgery, Kochi Medical School Hospital, 185-1, Kohasu, Okohcho, Nankoku-shi, Kochi Prefecture 783-8505, Japan
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2
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De Turck L, Sarens T, Veldeman L, Vonck A. For the love of muscles: a bodybuilder with complicated left ventricular heart failure. Acta Cardiol 2022; 77:774-777. [PMID: 35972452 DOI: 10.1080/00015385.2022.2080919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Anabolic-androgenic steroid misuse is associated with cardiovascular toxicity. We report a unique case of a 46-year-old male bodybuilder with nonischemic systolic heart failure complicated with a large left ventricular thrombus and multiple emboli presumably caused by long-term abuse of anabolic steroids. The patient experienced almost full recovery after cessation of anabolic steroid use, initiation of oral anticoagulation and guideline-directed heart failure medical therapy. This case illustrates the importance of early recognition and appropriate medical management of anabolic-androgenic steroid induced cardiomyopathy.
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Affiliation(s)
- Lidwina De Turck
- Department of Internal Medicine, AZ Sint-Blasius, Dendermonde, Belgium
| | - Tom Sarens
- Department of Cardiology, AZ Sint Blasius, Dendermonde, Belgium
| | - Laurens Veldeman
- Department of Endocrinology, AZ Sint Blasius, Dendermonde, Belgium
| | - An Vonck
- Department of Nephrology, AZ Sint Blasius, Dendermonde, Belgium
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3
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Eranki A, Villanueva C, Collins N, Seah P. Video assisted, transaortic removal of left ventricular thrombus during concurrent cardiac surgery: a case report. J Cardiothorac Surg 2021; 16:242. [PMID: 34446037 PMCID: PMC8390245 DOI: 10.1186/s13019-021-01626-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/29/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Left ventricular (LV) thrombus is a complication of acute myocardial infarction and is associated with systemic thromboembolism. We describe a trans-aortic endoscopic approach to the removal of an LV thrombus in a patient undergoing concurrent coronary artery bypass grafting and aortic valve replacement. Case presentation A 47 year old male presented following an embolic middle cerebral artery stroke and underwent transthoracic echocardiography demonstrating a mobile LV thrombus. Additional investigation revealed a moderately stenosed bicispid aortic valve, two vessel coronary artery disease and ischemic cardiomyopathy. The patient underwent early surgery to reduce the risk of further embolic episodes. A trans-aortic approach was utilized with videoscopy and single shafted instrumentation to aide in removal of the thrombus. The patient then underwent aortic valve replacement and coronary artery bypass grafting. Conclusion We report an alternative technique for the removal of a left ventricular thrombus in a patient undergoing concurrent coronary and aortic valve surgery. The transaortic video-assisted approach provided excellent visualisation of the apex and near complete removal of the thrombus without damaging the surrounding trabeculae. The main benefit of this technique is sparing of LV tissue, thereby preserving left ventricular function.
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Affiliation(s)
| | | | | | - Peng Seah
- John Hunter Hospital, Newcastle, Australia
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4
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Giant mobile left ventricular apical thrombus following silent infarction in a young patient: A case report. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.673142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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5
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Giant Left Ventricular Thrombus in a Patient with Acute Ischemic Stroke: A Case Report and Minireview. Case Rep Cardiol 2018; 2018:3714742. [PMID: 29581898 PMCID: PMC5821988 DOI: 10.1155/2018/3714742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/18/2017] [Indexed: 11/18/2022] Open
Abstract
A 56-year-old healthy male with no obvious risk factors or significant past medical history was admitted to the emergency room with acute ischemic stroke. On his transthoracic echocardiography (TTE), an extremely large thrombus was detected at the apex involving the distal anterior wall. The thrombus was predominantly adherent but with a mobile tip. The patient was subsequently managed with dual antiplatelet therapy. In this report, we present an interesting case of an acute ischemic stroke secondary to a giant left ventricular thrombus in a patient with no past significant cardiac or neurologic medical history.
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6
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Çil H, Yavuz C, Atilgan ZA, Gunduz E, Soydinc S. Complete Resolution of the Left Ventricular Pedunculated Thrombus with Tirofiban Infusion in a Patient with Severe Left Ventricular Dysfunction. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791302000508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 28-year-old man was admitted with symptoms of heart failure. Echocardiography revealed severe left ventricular dysfunction, apical aneurysm, and a 40 × 11 mm sized mobile thrombus attached to apical septum with a narrow stalk. The patient had anterior myocardial infarction two years ago. Heparin infusion was started at 1000 IU/hour for 48 hours. There was no detected change on the size of the thrombus. Surgery recommended to the patient was refused by him because of the procedural risks. Tirofiban infusion was started. Repeat echocardiography showed significant reduction in thrombus size after 24 hours, and complete resolution of the thrombus after 48 hours. To our knowledge, this is the first case with left ventricular mobile thrombus treated successfully with tirofiban infusion.
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7
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Minamishima T, Matsushita K, Morikubo H, Isaka A, Matsushita N, Endo H, Kubota H, Sakata K, Satoh T, Yoshino H. Considerations in cardio-oncology: Multiple mobile left-sided cardiac thrombi in chemotherapy-induced cardiomyopathy. J Infect Chemother 2017; 23:488-492. [PMID: 28285949 DOI: 10.1016/j.jiac.2017.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/01/2017] [Accepted: 02/07/2017] [Indexed: 11/26/2022]
Abstract
With advances in cancer chemotherapy, the importance of the new clinical discipline of cardio-oncology, which is concerned with the cardiac effects of chemotherapy, is increasing. Herein we describe the case of a 48-year-old woman with a history of breast cancer who presented with symptoms of heart failure due to chemotherapy-induced cardiomyopathy. Treatment for the patient's breast cancer had included surgery and chemotherapy with anthracyclines and trastuzumab. Echocardiography revealed multiple mobile thrombi in the left ventricle and atrium. In addition, brain magnetic resonance imaging revealed small acute cerebral infarctions due to embolization. Given the high risk of re-embolization, surgical thrombectomy was performed. Thus far, there are no standardized therapeutic guidelines for left-sided cardiac thrombi and the optimal treatment remains contentious. Although this patient was managed successfully with surgical thrombectomy, patients should be managed individually, taking into consideration embolization, bleeding, and surgical risks. With further improvements in cancer chemotherapy, there may be an increase in the incidence of complications such as multiple cardiac thrombi. From the cardio-oncology standpoint, we propose close interactions between cardiologists and oncologists for the optimal care of cancer patients.
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Affiliation(s)
- Toshinori Minamishima
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Kenichi Matsushita
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
| | - Hiromu Morikubo
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Aoi Isaka
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Noriko Matsushita
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Hidehito Endo
- Department of Cardiovascular Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Hiroshi Kubota
- Department of Cardiovascular Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Konomi Sakata
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Toru Satoh
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Hideaki Yoshino
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan
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Large Left Ventricular Thrombus in a Patient with Systemic and Venous Thromboembolism Secondary to Protein C and S Deficiency. Case Rep Cardiol 2017; 2017:7576801. [PMID: 28133551 PMCID: PMC5241470 DOI: 10.1155/2017/7576801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/15/2016] [Indexed: 11/18/2022] Open
Abstract
58-year-old Hispanic female presented with an altered mental status. A CT scan of the head demonstrated multiple scattered infarcts and a large right temporal lobe infarct. We also diagnosed the patient with right popliteal and femoral vein thrombosis, bilateral pulmonary embolism, and a transient right radial artery occlusion. Her 12-lead EKG showed lateral ST elevation. Emergent coronary angiogram revealed normal coronaries. Echocardiogram demonstrated a large mobile mass attached to the anterolateral free wall with overall normal contractility of the left ventricle. The patient underwent surgical embolectomy to prevent further systemic embolization. Coagulability workup returned positive for protein C and S deficiency. The patient did well after surgery. Following her surgery, we initiated chronic oral anticoagulation. The presentation with intracardiac thrombus in a normal heart should raise a concern of a probable thrombophilia.
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9
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Sartor L, Blázquez González JA, Al Razzo O, Monteagudo Vela M, Mesa Gracia JM. Trombectomía ventricular izquierda por vía transaórtica. CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2016.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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10
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Intracardiac thrombus and Murphy's law: Reflections on a clinical dilemma. Rev Port Cardiol 2016; 35:233.e1-3. [DOI: 10.1016/j.repc.2015.09.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 09/13/2015] [Indexed: 11/18/2022] Open
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11
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Rodrigues P, Sousa MJ, Caiado L, Cabral S, Meireles A, Santos M, Palma P, Torres S. Intracardiac thrombus and Murphy's law: Reflections on a clinical dilemma. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2015.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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12
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Sab S, Dhruva SS, Paulsen J, Sidhu RS, Amsterdam EA, Venugopal S. Here Today, Gone Tomorrow. Am J Med 2015; 128:e7-9. [PMID: 26302138 DOI: 10.1016/j.amjmed.2015.07.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 07/21/2015] [Accepted: 07/21/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Shiv Sab
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California (Davis) Medical Center, Sacramento
| | - Sanket S Dhruva
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California (Davis) Medical Center, Sacramento
| | - Jeffrey Paulsen
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California (Davis) Medical Center, Sacramento
| | - Ramanjeet Singh Sidhu
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California (Davis) Medical Center, Sacramento
| | - Ezra A Amsterdam
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California (Davis) Medical Center, Sacramento
| | - Sandhya Venugopal
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California (Davis) Medical Center, Sacramento.
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13
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Percutaneous coronary intervention for three vessels of chronic total occlusion complicated with huge left ventricular thrombus. Cardiovasc Interv Ther 2015; 31:321-8. [PMID: 26445952 DOI: 10.1007/s12928-015-0361-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 09/27/2015] [Indexed: 10/23/2022]
Abstract
A 55-year-old woman with symptoms of heart failure appeared to have ischemic cardiomyopathy complicated with 3-vessel chronic total occlusion (CTO), severely deteriorated left ventricular (LV) function, and large LV thrombus. Because of high risk of surgical thrombectomy in addition to coronary artery bypass grafting surgery, we first confirmed significant reduction of LV thrombus and performed percutaneous coronary intervention against the 3-vessel CTO under preceding anticoagulation therapy with warfarin, aspirin, and clopidogrel. By means of antegrade/retrograde approach, we successfully implanted everolimus-eluting stents one by one, leading to complete revascularization, dramatically improved LV function, and disappearance of LV thrombus without post-procedural embolism.
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14
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Williamson C, Sheehan LB, Venesy DM, D'Agostino RS. Transaortic, video-assisted removal of a mobile left ventricular apical thrombus in a patient with aortic stenosis and severe left ventricular dysfunction. J Thorac Cardiovasc Surg 2015; 151:e1-3. [PMID: 26515878 DOI: 10.1016/j.jtcvs.2015.09.091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/15/2015] [Accepted: 09/22/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Christina Williamson
- Department of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical, Center, Burlington, Mass.
| | - Lori B Sheehan
- Department of Anesthesiology, Lahey Hospital and Medical, Center, Burlington, Mass
| | - David M Venesy
- Department of Cardiology, Lahey Hospital and Medical Center, Burlington, Mass
| | - Richard S D'Agostino
- Department of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical, Center, Burlington, Mass
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15
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Abstract
Patient with embolic episode should always be evaluated for cardiac mass. Mass in left ventricular can be a myxoma or thrombus even in a normal functioning heart. In either case, mobile mass with embolic potential should be surgically resected.
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Affiliation(s)
- Monish S Raut
- Department of Cardiac Anesthesia and Cardiac Surgery, Dharam Vira Heart Center, Sir Ganga Ram Hospital, New Delhi, India
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16
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Kharwar RB, Chandra S, Dwivedi SK, Saran RK. A pedunculated left ventricular thrombus in a women with peripartum cardiomyopathy: evaluation by three dimensional echocardiography. J Cardiovasc Ultrasound 2014; 22:139-43. [PMID: 25309691 PMCID: PMC4192412 DOI: 10.4250/jcu.2014.22.3.139] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 03/31/2014] [Accepted: 08/20/2014] [Indexed: 12/05/2022] Open
Abstract
Peripartum cardiomyopathy is a cardiac condition characterized by development of heart failure during the last month of pregnancy or during the first five months of post partum period without any other identifiable cause of heart failure. The hypercoagulable state in the pregnancy along with left ventricular (LV) systolic dysfunction predisposes the patient to thromboembolic complications like intraventricular thrombi. We report a case of a 30-year-old female with peripartum cardiomyopathy along with a highly mobile mass in the LV cavity on two dimensional echocardiography. Three dimensional transthoracic echocardiography clearly showed the pedicle of the mass attached to the interventricular septum along with internal echolucent areas within the mass. Due to denial of the patient to undergo surgery, she was started on oral anticoagulation, with complete dissolution of the mass within one month.
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Affiliation(s)
| | - Sharad Chandra
- Department of Cardiology, King Georges' Medical University, Lucknow, India
| | | | - Ram Kirti Saran
- Department of Cardiology, King Georges' Medical University, Lucknow, India
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Leick J, Szardien S, Liebetrau C, Willmer M, Fischer-Rasokat U, Kempfert J, Nef H, Rolf A, Walther T, Hamm C, Möllmann H. Mobile left ventricular thrombus in left ventricular dysfunction: case report and review of literature. Clin Res Cardiol 2013; 102:479-84. [PMID: 23584757 DOI: 10.1007/s00392-013-0565-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 04/03/2013] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Left ventricular (LV) thrombi carry a high risk of embolization. Therapeutic recommendations like treatment with low molecular heparin and intravenous unfractionated heparin (UFH), thrombolysis or surgical thrombectomy have failed to reach a consensus. CASE DESCRIPTION A 56-year-old female patient presented in cardiogenic shock to the emergency department. Echocardiography demonstrated a dilated LV with a severely depressed global systolic function and a large LV apical thrombus. Treatment with UFH was initiated as well as a treatment with catecholamines for stabilizing the patient's hemodynamic situation. On the follow-up echocardiographic examination, extensive free-floating parts of the thrombus could be documented. Given the high risk of embolization in a now hemodynamically stable situation, emergency surgical embolectomy was performed. DISCUSSION A conservative procedure might be useful for bridging till surgical treatment is available and/or the risk due to surgery is acceptable. CONCLUSION In absence of evidence-based guidelines for the treatment of LV thrombi, individualized management options concerning surgical, embolization and bleeding risk must be taken into account.
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Affiliation(s)
- Jürgen Leick
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
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18
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Lee JM, Park JJ, Jung HW, Cho YS, Oh IY, Yoon CH, Suh JW, Chun EJ, Choi SI, Youn TJ, Lim C, Cho GY, Chae IH, Park KH, Choi DJ. Left ventricular thrombus and subsequent thromboembolism, comparison of anticoagulation, surgical removal, and antiplatelet agents. J Atheroscler Thromb 2012; 20:73-93. [PMID: 22986555 DOI: 10.5551/jat.13540] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
UNLABELLED Left ventricular (LV) thrombus is one of the risk factors for systemic thromboembolism. The aims of this study were to compare the long-term clinical outcomes of LV thrombus using current therapeutics, anticoagulation, operative treatment, and antiplatelet agents and to identify independent predictors of systemic thromboembolism. METHODS We screened 86,374 patients for intracardiac thrombus in the electronic medical records and imaging databases. Records of 62 patients with LV thrombus, diagnosed between May 2003 to November 2011, were comprehensively reviewed regarding baseline characteristics, imaging data and thrombus outcomes, thromboembolic events and treatment complications by treatment group. RESULTS The majority (80.6%) had ischemic etiology. Systemic thromboembolism developed in 18 patients; 8 (45%) were post-treatment thromboembolisms while 10 events occurred before treatment began. No post-treatment thromboembolism occurred in the operative treatment group; in contrast, 7 post-treatment thromboembolisms occurred in anticoagulation group (17%) (Log rank p= 0.175). Independent predictors of post-treatment thromboembolism were dilated cardiomyopathy (HR 61.30, p= 0.001), previous cerebrovascular events (HR 7.06, p= 0.042), female gender (HR 7.11, p= 0.031), and echocardiographic left ventricular end-diastolic diameter (HR 1.15, p= 0.047). CONCLUSIONS In this study, the rate of post-treatment thromboembolism was not significantly different among the treatment groups; however, operative treatment tended towards less post-treatment thromboembolism than other treatment groups.
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Affiliation(s)
- Joo Myung Lee
- Seoul National University Hospital, Seoul, South Korea
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19
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Surgical treatment of giant left ventricular apical thrombus diagnosed with contrast echocardiography in patient with previous anterior myocardial infarction. J Cardiovasc Echogr 2012. [DOI: 10.1016/j.jcecho.2012.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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20
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Jeon GJ, Song BG, Park YH, Kang GH, Chun WJ, Oh JH. Acute Stroke and Limb Ischemia Secondary to Catastrophic Massive Intracardiac Thrombus in a 40-Year-Old Patient With Dilated Cardiomyopathy. Cardiol Res 2012; 3:37-40. [PMID: 28357023 PMCID: PMC5358295 DOI: 10.4021/cr142w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2012] [Indexed: 11/03/2022] Open
Abstract
Dilated cardiomyopathy has been associated with left ventricular (LV) thrombosis which leads to substantial morbidity and mortality as a site for systemic emboli. We report an interesting case of a stroke and acute limb ischemia secondary to a large mobile pedunculated LV thrombus in 40-year-old patient with dilated cardiomyopathy.
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Affiliation(s)
- Gi Jung Jeon
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Bong Gun Song
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Yong Hwan Park
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Gu Hyun Kang
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Woo Jung Chun
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Ju Hyeon Oh
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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21
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Seitz MJ, McLeod MK, O'Keefe MD, Seah PW. A rare cause of Takotsubo cardiomyopathy related left ventricular apical thrombus requiring surgery. Heart Lung Circ 2011; 21:245-6. [PMID: 21840755 DOI: 10.1016/j.hlc.2011.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 05/17/2011] [Accepted: 07/10/2011] [Indexed: 11/26/2022]
Abstract
We present the case of a 48 year-old male with a history of cystic fibrosis who presented with massive haemoptysis and was later found to have Takotsubo cardiomyopathy. He subsequently developed a left ventricular (LV) thrombus which was successfully removed via a left apical ventriculotomy. Surgical management of LV thrombus related to Takotsubo cardiomyopathy is warranted in a selected population of patients and a left apical ventriculotomy provides good access with minimal complications in the post operative setting.
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Affiliation(s)
- Michael J Seitz
- Department of Cardiothoracic Surgery, John Hunter Hospital, Lookout Road, New Lambton, NSW 2305, Australia.
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22
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Kawarada O, Yokoi Y. Brain salvage for cardiac cerebral embolism following myocardial infarction. Catheter Cardiovasc Interv 2010; 75:679-83. [PMID: 20020521 DOI: 10.1002/ccd.22330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Acute ischemic stroke due to thromboembolism from the left ventricle is a serious complication following myocardial infarction (MI). Despite the attention given to acute stroke intervention, peri-MI ischemic stroke is an underappreciated condition. Here, we describe a case of acute cardiac thromboembolic occlusion of the middle cerebral artery with preceding MI in which brain salvage was achieved by balloon angioplasty.
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Affiliation(s)
- Osami Kawarada
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada-city, Osaka, Japan.
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Niedeggen A, Lejczyk J, Kroner S, Stortz C, Reith S, Janssens U. Treatment of intracardiac thrombi with argatroban. ACTA ACUST UNITED AC 2009; 10:221-6. [PMID: 18720086 DOI: 10.1080/17482940802262384] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Intracardiac thrombi are well known complications associated with diverse cardiac diseases and venous thromboembolism. Therapeutic recommendations like thrombolysis, surgical thrombectomy, or treatment with low molecular heparin and intravenous unfractionated heparin based on small numbers of patients or retrospective case series have failed to reach a consensus. We report on the use of argatroban, a new direct thrombin inhibitor in 4 patients with intracardiac thrombi. Therapy was effective in all patients with complete resolution of thrombi. Treatment was complicated by recurrent strokes with complete neurological recovery in one patient. Therapy of intracardiac thrombi by argatroban is safe and effective. The drug requires no dosage adjustments for age, sex, or renal impairment, including in dialysis-dependent patients. Argatroban has been found to increase predictably activated partial thromboplastin time (aPTT) and activated clotting time (ACT) in a dose-dependent manner.
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Lee KH, Yoon MJ, Han MY, Chung SJ, Kim SC. Surgical removal of a left ventricular thrombus caused by acute myocarditis. KOREAN JOURNAL OF PEDIATRICS 2007. [DOI: 10.3345/kjp.2007.50.6.588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kyu Ha Lee
- Department of Pediatrics, Kyunghee University College of Medicine, Seoul, Korea
| | - Min Jung Yoon
- Department of Pediatrics, Kyunghee University College of Medicine, Seoul, Korea
| | - Mi Young Han
- Department of Pediatrics, Kyunghee University College of Medicine, Seoul, Korea
| | - Sa Jun Chung
- Department of Pediatrics, Kyunghee University College of Medicine, Seoul, Korea
| | - Soo Cheol Kim
- Department of Thoracic & Cardiovascular Surgery, Kyunghee University College of Medicine, Seoul, Korea
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25
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Kuh JH, Seo Y. Transatrial resection of a left ventricular thrombus after acute myocarditis. Heart Vessels 2006; 20:230-2. [PMID: 16160906 DOI: 10.1007/s00380-004-0811-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2004] [Accepted: 11/09/2004] [Indexed: 12/25/2022]
Abstract
A mobile and pedunculated left ventricular thrombus developed after acute myocarditis in a 49-year-old woman. Surgical removal is recommended for cases such as this, especially when the ventricular thrombus is pedunculated or mobile. The thrombus was successfully removed by left atriotomy. There was no evidence of recurrent thrombus formation on the 50th day after surgery.
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Affiliation(s)
- Ja Hong Kuh
- Department of Thoracic and Cardiovascular Surgery, Chonbuk University Hospital, 634-18 Keum am-Dong, Duck Jin-Gu, Jeon Ju 561-182, South Korea
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Meurin P, Tabet JY, Renaud N, Weber H, Grosdemouge A, Bourmayan C, Driss AB. Treatment of left ventricular thrombi with a low molecular weight heparin. Int J Cardiol 2005; 98:319-23. [PMID: 15686785 DOI: 10.1016/j.ijcard.2004.02.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2003] [Revised: 02/09/2004] [Accepted: 02/27/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Once a diagnosis of left ventricular thrombus has been established, the classical attitude consists in the administration of unfractionated heparin relayed by oral anticoagulation therapy. However, the use of unfractionated heparins in this indication was only assessed in an open, non-randomized study with no control group, including 23 patients. On the other hand, although low molecular weight heparins are routinely used in some departments, there are no studies available concerning these agents in this indication. The aim of this study was to evaluate the feasibility of low molecular weight heparin therapy in patients with left ventricular thrombi. METHODS The study was a prospective, non-randomized, open-label trial. All patients with a new left ventricular thrombus diagnosed between September 2000 and September 2003 received enoxaparine 100 IU/kg twice daily for a mean duration of 13 days. A relay treatment with fluindione was initiated on day 5. The left ventricular thrombus outcome was followed for 3 weeks by bi-weekly transthoracic echocardiography. RESULTS 26 left ventricular thrombi were diagnosed over the 3-year study period: 19 in post-infarct patients with a history of anterior myocardial infarction and 7 in patients with dilated cardiomyopathy. The mean thrombus area decreased from 2.30+/-0.32 to 0.36+/-0.11 cm2 (p<0.0001). Nineteen thrombi out of twenty-six (73%) disappeared during the treatment period. No thrombocytopenia or hemorrhagic events were observed. One transient ischemic attack was reported. CONCLUSION This preliminary study suggests that low molecular weight heparins are well tolerated and efficient in terms of left ventricular thrombi disappearance or size reduction.
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Affiliation(s)
- Philippe Meurin
- Centre de Réadaptation Cardiaque de la Brie, Les Grands Prés, 27, rue Sainte Christine, 77174 Villeneuve Saint Denis, France.
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27
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Lin CP, Tsai FC, Chu PH, Jung SM, Lim KE, Kuo CT, Lee YS. Acute myocardial infarction in a young man complicated with left ventricular thrombi. JAPANESE HEART JOURNAL 2004; 45:1029-35. [PMID: 15655278 DOI: 10.1536/jhj.45.1029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Premature coronary artery disease is very rare and complication with thrombus formation in the left ventricle is rarer still. A 23-year-old man was admitted to hospital for recent acute myocardial infarction after being struck by a basketball eight days previously. Echocardiography identified two peduncle thrombi at the apex of the left ventricle, which were confirmed with computed tomography. The proximal left anterior descending coronary artery was totally occluded. Following two weeks of treatment with heparin and warfarin, the patient agreed to undergo a coronary artery bypass graft and thrombectomy. The ecchymosed tissue around the coronary artery implied that a trauma injury might have been the cause of the coronary artery disease in this case. This work reviews the pathophysiology and natural history of coronary artery disease in a case of very young myocardial infarction.
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Affiliation(s)
- Chia-Pin Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei 105, Taiwan
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28
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Fortier S, Demaria RG, Pelletier GB, Carrier M, Perrault LP. Left ventricular thrombectomy in a cocaine user with normal coronary arteries. J Thorac Cardiovasc Surg 2003; 125:204-5. [PMID: 12539009 DOI: 10.1067/mtc.2003.118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- S Fortier
- Department of Surgery, Montreal Heart Institute, Montreal, Quebec, Canada
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29
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Abstract
Postinfarction left ventricular thrombi are at risk for embolization with resultant injury. Surgical removal is recommended especially if they are pedunculated or mobile. We describe an easily applied transatrial method that can allow avoidance of a ventriculotomy.
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Affiliation(s)
- G L Early
- Department of Surgery, Kansas University Medical Center, Kansas City, USA
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Tsukube T, Okada M, Ootaki Y, Tsuji Y, Yamashita C. Transaortic video-assisted removal of a left ventricular thrombus. Ann Thorac Surg 1999; 68:1063-5. [PMID: 10510010 DOI: 10.1016/s0003-4975(99)00662-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A mobile and pedunculated left ventricular thrombus was developed after acute myocardial infarction in a 59-year-old man, and was successfully removed surgically through the aortic valve using a video-assisted thoracoscope. Transaortic video-assisted thoracoscopy greatly facilitated exposure of the interior of the left ventricle and preserved left ventricular function by avoiding ventriculotomy.
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Affiliation(s)
- T Tsukube
- Department of Surgery, Division II, Kobe University School of Medicine, Japan.
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32
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Glikson M, Agranat O, Ziskind Z, Kaplinski E, Vered Z. From swirling to a mobile, pedunculated mass--the evolution of left ventricular thrombus despite full anticoagulation. Echocardiographic demonstration. Chest 1993; 103:281-3. [PMID: 8417899 DOI: 10.1378/chest.103.1.281] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
We describe the unusual evolution of a left ventricular thrombus following acute anterior myocardial infarction despite adequate anticoagulation. Serial echocardiographic examinations demonstrated the evolution from swirling in the left ventricle through a solid apical mass gradually dislodging into a mobile, pedunculated mass that was removed surgically to prevent embolization. This report emphasizes the need to follow echocardiographically left ventricular thrombi during treatment with anticoagulants, and to identify morphologic changes that may predict embolization. This case suggests that left ventricular thrombectomy should be considered in selected patients in whom a very high-risk thrombus morphology is detected.
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Affiliation(s)
- M Glikson
- Heart Institute, Tel Aviv University, Tel Hashomer, Israel
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Affiliation(s)
- S M Butman
- Department of Internal Medicine, University of Arizona, Tucson
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34
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John RM, Sturridge MF, Swanton RH. Pedunculated left ventricular thrombus--report of two cases. Postgrad Med J 1991; 67:843-5. [PMID: 1946132 PMCID: PMC2399112 DOI: 10.1136/pgmj.67.791.843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In two patients presenting with myocardial infarction, one with a subendocardial infarction and the second patient with a classic Q wave infarction, pedunculated left ventricular thrombi were detected in the course of subsequent routine cardiac catheterization. Both patients underwent successful surgical thrombectomy.
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Affiliation(s)
- R M John
- Department of Cardiology, Middlesex Hospital, London, U.K
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35
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Smolinsky A, Ziskind Z, Mohr R, Goor DA, Motro M. Left ventricular thrombectomy in the early postinfarction period. Thorax 1990; 45:548-51. [PMID: 2204144 PMCID: PMC462587 DOI: 10.1136/thx.45.7.548] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Emergency left ventricular thrombectomy was performed on four patients soon after infarction. In three patients surgery was carried out after embolisation had occurred and when a large, residual, protruding, mobile thrombus remained in the left ventricle. Surgery was performed in the fourth patient after a high risk thrombus was detected and initial attempts to lyse it had failed. All four patients had an uneventful recovery and were discharged within two weeks of surgery. These cases indicate that the therapeutic option of left ventricular thrombectomy is feasible for patients with acute infarcts and problematic left ventricular thrombi.
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Affiliation(s)
- A Smolinsky
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Israel
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Leor J, Agranat O, Mohr R, Kaplinsky E, Motro M. Urgent surgical removal of a rapidly growing left ventricular thrombus following acute myocardial infarction. Am Heart J 1990; 119:1199-201. [PMID: 2330878 DOI: 10.1016/s0002-8703(05)80255-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- J Leor
- Heart Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel
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