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Rathnayake A, Chang O, Narita T, Mejia R. Aortic mural thrombus in a normal ascending aorta. ANZ J Surg 2022; 92:3082-3083. [PMID: 35178896 DOI: 10.1111/ans.17546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/07/2021] [Accepted: 02/05/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | - Olivia Chang
- Cardiothoracic Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Takuya Narita
- Cardiothoracic Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Rosauro Mejia
- Cardiothoracic Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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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 Vasa 2019. [DOI: 10.1016/j.crvasa.2018.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Arora NP, Joumaa M, Rosman H, Mehta R. Left Main Coronary Artery Thrombosis With Acute Myocardial Infarction: A Management Dilemma. Am J Med Sci 2017; 353:597-602. [PMID: 28641723 DOI: 10.1016/j.amjms.2016.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Left main coronary artery (LMCA) thrombosis with acute myocardial infarction is a rare condition with very high mortality. The low incidence of this condition and exclusion of patients with LMCA thrombosis from clinical trials prevent the development of optimal management strategy in these patients. Therefore, there are no clear-cut guidelines describing an evidence-based approach for this condition. We describe a patient with LMCA thrombosis presenting with acute myocardial infarction, who was found to have hypercoagulable state related to homocysteinemia on further work-up. This case highlights the challenges faced during the management of this rare condition due to lack of clear-cut guidelines describing an evidence-based approach.
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Ozaki N, Yuji D, Sato M, Inoue K, Wakita N. A floating thrombus in the ascending aorta complicated by acute myocardial infarction. Gen Thorac Cardiovasc Surg 2017; 65:213-5. [PMID: 26728032 DOI: 10.1007/s11748-015-0619-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/16/2015] [Indexed: 10/22/2022]
Abstract
A 37-year-old male was transferred to our hospital with a diagnosis of acute myocardial infarction and a mass in the ascending aorta. Echocardiography revealed dyskinesia on the left ventricular apex and a floating mass lesion just above the aortic valve. Acute myocardial infarction was considered to be caused by embolism from the floating mass in the ascending aorta. Emergency surgery was successfully performed and histological examination showed the extirpated mass in the ascending aorta was thrombus. The patient has been well on oral anticoagulant and no recurrence has been seen on echocardiogram 4 years after the operation.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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:
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Nakamura D, Makino N, Egami Y, Shutta R, Tanouchi J, Nishino M. Successful thrombectomy for coronary embolism likely due to floating aortic plaque in ascending aorta. Cardiovasc Interv Ther 2014; 30:299-302. [DOI: 10.1007/s12928-014-0291-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 07/28/2014] [Indexed: 10/24/2022]
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Gülcü A, Gezer NS, Men S, Öz D, Yaka E, Öztürk V. Management of free-floating thrombus within the arcus aorta and supra-aortic arteries. Clin Neurol Neurosurg 2014; 125:198-206. [PMID: 25173962 DOI: 10.1016/j.clineuro.2014.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 07/18/2014] [Accepted: 08/07/2014] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Clinical management strategy and the best treatment option of free floating thrombus (FFT), detected in patients with acute ischemic cerebrovascular diseases is still uncertain due to the rarity of these conditions. Recent studies emphasize that FFT within cerebral vessels may not be a surgical emergency since complete dissolution without any further neurologic progression occurred in 86% of patients treated medically. The aim of this study was to investigate the effect of medical treatment on the fate of thrombus and the clinical status in acute cerebrovascular event patients with detected FFT in the artery feeding the compromised brain territory at the time of diagnosis. MATERIALS AND METHODS We have retrospectively reviewed the initial and follow up computed tomography angiography, diffusion-weighted magnetic resonance imaging examinations of 37 acute ischemic stroke patients with detected FFT and treated medically. The patients were evaluated for any change of the FFT, residual stenosis after the FFT shrunk or disappeared and neurologic outcome. RESULTS FFT was located in cervical carotid artery, intracranial artery and arcus aorta in 23, 6 and 5 of the patients respectively. Dissection accompanied the FFT in 3 patients. Recanalization was maintained in 34 patients however, three of them suffered from new infarctions. A total occlusion was detected in three patients. Two of them had new infarcts while one was stable during clinical follow-up period. CONCLUSION The results of our retrospective study have shown that FFT in the proximal aorta and supra-aortic arteries tend to resolve with anticoagulant and/or antiplatelet treatment without causing recurrent adverse events in most of the cases. Furthermore, resolution of the clot seems to provide a safer ground for a recanalization procedure like stenting or endarterectomy if needed.
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Affiliation(s)
- Aytaç Gülcü
- Department of Radiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
| | - Naciye Sinem Gezer
- Department of Radiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
| | - Süleyman Men
- Department of Radiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
| | - Didem Öz
- Department of Neurology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
| | - Erdem Yaka
- Department of Neurology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
| | - Vesile Öztürk
- Department of Neurology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
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Nishizaki F, Tomita H, Abe N, Kimura M, Higuma T, Osanai T, Yamauchi S, Daitoku K, Fukuda I, Kamata Y, Okumura K. Acute myocardial infarction caused by a floating thrombus in the ascending aorta: A role of CD34-positive endothelial cells. J Cardiol Cases 2013; 8:e88-e90. [PMID: 30546751 DOI: 10.1016/j.jccase.2013.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 03/28/2013] [Accepted: 04/06/2013] [Indexed: 12/01/2022] Open
Abstract
A 49-year-old woman was transferred to our hospital with acute-onset chest pain. Her electrocardiogram showed complete atrioventricular block and bradycardia with ST-segment elevation in the inferior leads, and she presented with cardiogenic shock. She was diagnosed with inferior acute myocardial infarction (AMI), and subsequent emergency cardiac catheterization was performed. Selective coronary angiography showed neither stenosis nor obstruction in any of the coronary arteries. Left ventriculography showed a large floating object located on the ascending aortic wall above the ostium of the right coronary artery (RCA). Chest enhanced computed tomography confirmed the floating object in the ascending aorta. These findings suggested that the floating object was associated with the RCA occlusion. To remove the floating object, emergency surgery was performed. The floating object was a large thrombus derived from the localized atheromatous plaque in the ascending aorta. Specialized immunostaining for surface antigen CD34 revealed that regenerated endothelial cells were present on the erosion, along the stalk, and on the floating thrombus. These findings indicate that the CD34-positive endothelial precursor cells strayed into the surface and/or inside of the thrombus, and consequently the floating thrombus supported by these regenerated endothelial cells occluded the RCA, causing AMI. <Learning objective: A free floating thrombus formed in the ascending aorta can cause obstruction of the coronary artery ostium, leading to AMI. This unusual cause of AMI mostly occurs in females, and shows high mortality rates. Although the risk factors are known to be current smoking, oral hormone therapy, and hypercoagulable state such as pregnancy, the underlying mechanism of thrombus formation is still unclear. This report describes a possible role of CD-34 positive regenerated endothelial cells in thrombus formation.>.
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Affiliation(s)
- Fumie Nishizaki
- Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
| | - Hirofumi Tomita
- Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
| | - Naoki Abe
- Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
| | - Masaomi Kimura
- Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
| | - Takumi Higuma
- Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
| | - Tomohiro Osanai
- Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
| | - Sanae Yamauchi
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori 036-8562, Japan
| | - Kazuyuki Daitoku
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori 036-8562, Japan
| | - Ikuo Fukuda
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori 036-8562, Japan
| | - Yoshimasa Kamata
- Hospital Pathology Center, Hirosaki University Graduate School of Medicine, Aomori 036-8562, Japan
| | - Ken Okumura
- Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
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Fayad ZY, Semaan E, Fahoum B, Briggs M, Tortolani A, D’Ayala M. Aortic Mural Thrombus in the Normal or Minimally Atherosclerotic Aorta. Ann Vasc Surg 2013; 27:282-90. [DOI: 10.1016/j.avsg.2012.03.011] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 03/09/2012] [Accepted: 03/17/2012] [Indexed: 10/27/2022]
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Taghipour HR, Farahani MM, Ghiasi S, Naseri MH, Fakhraddin F. Coincidence of free-floating thrombus in the aortic arch, severe mitral stenosis, and left atrial appendage clot. Heart Surg Forum 2011; 14:E252-4. [PMID: 21859646 DOI: 10.1532/hsf98.20101147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe the surgical management of a free-floating thrombus in the aortic arch in a patient with severe mitral stenosis, a left atrial appendage (LAA) clot, and an iliac artery thrombus. A 60-year-old woman complaining of dyspnea and pain in her right leg was referred to our multidisciplinary clinic. After a brief history was taken, an electrocardiography evaluation showed atrial fibrillation. Color Doppler sonography of the lower limb arteries showed decreased blood flow in distal branches of the internal iliac artery of the right leg. Transthoracic and transesophageal echocardiography evaluations revealed severe mitral stenosis, a large LAA clot, and a large mobile mass (2 × 1.5 × 1.5 cm) in the distal aortic arch. Additional investigations with computed tomographic angiography revealed that the thrombus extended from the aortic arch to the subclavian artery. Another bulky thrombus in the right iliac artery was also found. Given this complicated medical situation, emergency cardiac surgery was performed, and the clot was removed. The stenotic mitral valve was replaced with a prosthetic valve, The LAA was closed after clot removal, and the bulky thrombus was extracted from the right iliac artery. Transesophageal echocardiographic data were obtained postoperatively, and the patient's course in the intensive care unit was favorable. She was discharged from the hospital in good condition on warfarin, digoxin, aspirin, and metoprolol.
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Affiliation(s)
- Hamid Reza Taghipour
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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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.
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Affiliation(s)
- Takahiro Sawada
- Department of Cardiovascular Surgery, Teikyo University Hospital, Itabashi-Ku, Tokyo 173-8605, Japan.
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Soeda T, Okayama S, Seno A, Kawakami R, Somekawa S, Takeda Y, Uemura S, Saito Y. Contrast-enhanced computed tomographic and echocardiographic detection of intra-aortic floating thrombus causing acute myocardial infarction. J Cardiovasc Comput Tomogr 2011; 5:63-5. [DOI: 10.1016/j.jcct.2010.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Revised: 09/05/2010] [Accepted: 09/17/2010] [Indexed: 11/26/2022]
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Pawlaczyk R, Lango R, Klapkowski A, Rogowski J. Low Cardiac Output Due to Left Main Coronary Embolism During Mitral Valve Replacement. J Card Surg 2010; 25:658-60. [DOI: 10.1111/j.1540-8191.2010.01044.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Akyildiz M, Zorman Y, Aksoy T, Yilmazer MS, Erturk E, Onar CL, Midi A. Giant Floating Thrombus Localized in the Ascending Aorta. Heart Surg Forum 2010; 13:E195-7. [DOI: 10.1532/hsf98.20091072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Baldini U, Chiaramonti F, Minzioni G, Galli M. A hanging mass in the ascending aorta diagnosed by transthoracic echocardiography in a totally asymptomatic subject. J Am Soc Echocardiogr 2010; 22:1197.e5-7. [PMID: 19801313 DOI: 10.1016/j.echo.2009.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Indexed: 11/17/2022]
Abstract
Aortic mural thrombosis is generally associated with several diseases, including coagulopathies, aortic dissection or trauma, tumors, and complicated atherosclerotic plaques. The development of a friable mobile thrombus, especially in the ascending aorta or proximal aortic arch, is a rare event with potentially ominous consequences because of a life-threatening risk of stroke and peripheral embolization. The treatment of choice of this condition is still controversial. We report a case of an absolutely asymptomatic 57-year-old patient with a mobile, pedunculated mass attached to the posterior wall of an otherwise normal ascending aorta. The aortic mass, identified by transthoracic echocardiography, was surgically removed and demonstrated to be a thrombus, and the aortic wall specimen was microscopically normal.
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Nakajima M, Tsuchiya K, Honda Y, Koshiyama H, Kobayashi T. Acute pulmonary embolism after cerebral infarction associated with a mobile thrombus in the ascending aorta. Gen Thorac Cardiovasc Surg 2009; 57:654-6. [DOI: 10.1007/s11748-009-0444-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 04/06/2009] [Indexed: 10/20/2022]
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Sanon S, Phung MK, Lentz R, Buja LM, Tung PP, Mcpherson DD, Fuentes F. Floating, Non-Occlusive, Mobile Aortic Thrombus and Splenic Infarction Associated With Protein C Deficiency. J Am Soc Echocardiogr 2009; 22:1419.e1-3. [DOI: 10.1016/j.echo.2009.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Indexed: 11/19/2022]
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Luckeroth P, Steppacher R, Rohrer MJ, Eslami MH. Endovascular Therapy for Symptomatic Mobile Thrombus of Infrarenal Abdominal Aorta. Vasc Endovascular Surg 2009; 43:518-23. [DOI: 10.1177/1538574409334823] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mobile thrombus is a rare cause of distal arterial embolization. We report 2 cases of mobile thrombus of the abdominal aorta leading to distal embolization. Both patients were successfully treated with endovascular exclusion of the thrombus and distal embolectomy. Endovascular exclusion of a mobile thrombus of the abdominal aorta is a significantly less invasive alternative to open abdominal aorta thrombectomy.
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Affiliation(s)
- Patricia Luckeroth
- Departments of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Robert Steppacher
- Division of Vascular Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Michael J. Rohrer
- Division of Vascular Surgery, University of Tennessee Medical School, Memphis, Tennessee
| | - Mohammad H. Eslami
- Division of Vascular Surgery, University of Massachusetts Medical School, Worcester, Massachusetts,
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Madershahian N, Kuhn-Regnier F, Mime LB, Slottosch I, Langebartels G, Sindhu D, Wahlers T. A Loose Cannon: Free-Floating Thrombus in Ascending Aorta. J Card Surg 2009; 24:198-9. [DOI: 10.1111/j.1540-8191.2008.00684.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Iyer AP, Sadasivan D, Kamal U, Sharma S. Resolution of Large Intra-Aortic Thrombus Following Anticoagulation Therapy. Heart Lung Circ 2009; 18:49-50. [DOI: 10.1016/j.hlc.2007.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Accepted: 09/12/2007] [Indexed: 10/22/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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Affiliation(s)
- M Knoess
- Institute of Clinical Pathology, Moltkestrasse 32, 54292 Trier, Germany.
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Szabolcs Z, Veres G, Hüttl T, Bíró G, Tóth A, Szeberin Z, Windisch M, Acsády G. [A simple surgical method for removing a large floating thrombus from the ascending aorta]. Orv Hetil 2007; 148:363-6. [PMID: 17344160 DOI: 10.1556/oh.2007.27975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report the successful surgical removal of a large floating thrombus from the ascending aorta causing systemic embolization. It was diagnosed by transesophageal echocardiography (TEE), CT scan, aortography and Cardiovascular Magnetic Resonance Imaging (CMR). The free-floating, highly embolic source 2 cm distal to the left coronary sinus was removed from the ascending aorta using a simple surgical technique. Isolated cerebral perfusion with circulatory arrest on normothermia provided a simple and safe access to the thrombus attached to a ruptured atherosclerotic plaque. The patient was discharged on the 7 th postoperative day after an uneventful recovery.
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Affiliation(s)
- Zoltán Szabolcs
- Semmelweis Egyetem, Altalános Orvostudományi Kar Er- és Szívsebészeti Klinika Budapest Városmajor utca 68, 1122.
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Abstract
Floating thrombus in the ascending aorta is an uncommon source of embolism. We report a case of a 61-year-old man who was admitted to our hospital for transient brain ischemic attack. Transesophageal echocardiography showed a floating mass on the sinotubular junction. We started anticoagulation therapy immediately and performed surgical removal of the mass 5 days after the admission. Postoperative course was uneventful. He is now in good health and has no sign of recurrence. The etiology of this case is unclear, and the strategy is difficult to determine in terms of cerebral complications.
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Affiliation(s)
- Motoyuki Hisagi
- Department of Cardiothoracic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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Affiliation(s)
- Pmerre V Ennezat
- Intensive Care Unit, Cardiology Hospital, Bd Pr J. Leclercq, 59000 Lille, France.
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Abstract
Left main coronary artery (LMCA) thrombosis with acute myocardial infarction is an uncommon condition with an extremely high mortality. The small number of reported cases prevents the development of an evidence-based approach. Hence there are no clear-cut guidelines describing the best management approach for this condition. We describe our experience with six patients who presented with LMCA thrombosis and discuss the epidemiology, etiology and management options available for this high-risk subgroup.
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Affiliation(s)
- Rajiv Gupta
- Division of Cardiology, Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas, 77555-0553, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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Affiliation(s)
- Allan L Wolfsohn
- Division of Anatomical Pathology, Ottawa Hospital, Ottawa, ON, Canada, K1Y 4E9.
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Abstract
We report the case of a 55-year-old woman seen with signs of angina pectoris and dyspnea. Transesophageal echocardiography showed a floating thrombus distal to the right coronary ostium. At operation, we found a highly mobile thrombus attached to an atherosclerotic plaque distal to the right coronary ostium. The atherosclerotic lesion and the pedunculated thrombotic mass were removed without resection of the adjacent aortic wall. In our judgment, a floating mass in the ascending aorta represents an emergency and should be removed before major thromboembolic complications occur.
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Affiliation(s)
- Ralf Sodian
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany.
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