Video assisted, transaortic removal of left ventricular thrombus during concurrent cardiac surgery: a case report

Robotic transmitral resection of floating left ventricular thrombus

Despite the role of surgery in the management of left ventricular (LV) thrombi remaining controversial, robotic LV thrombectomy has emerged as a viable treatment option. This study aimed to present our successful experience with a robotic mitral program, detailing the operative technique. We conducted a retrospective analysis of our institutional database to identify patients who underwent LV thrombectomy using the da Vinci robot system. Subsequently, serial echocardiograms and short- and long-term outcomes were reviewed and analyzed using descriptive statistics. Five patients (median age: 46 years) were included in this study. All patients presented with a floating LV thrombus and a history of embolization. Among them, four patients experienced reduced heart function, none had coronary artery disease, three experienced dilated cardiomyopathy. Complete resection was achieved in all cases, with no postoperative deaths, strokes, or major complications. In addition, LV function showed improvement during follow-up periods. Postoperative anticoagulation was continued for 2 years in one patient and 1 year in the remaining patients. No recurrence or further embolic events were observed during the median follow-up period of 6 years. Robotic LV thrombectomy yields excellent outcomes and should be considered early for patients with floating LV thrombi. However, further investigation is warranted to determine the optimal timing of this intervention and its role in the treatment paradigm, including whether these results can be extrapolated to patients with other forms of mobile thrombus and/or to support surgery as the primary prevention of systemic embolization.

Acute Lymphocytic Myocarditis With Mobile Left Ventricular Thrombus

A left ventricular thrombus (LVT) in cardiac disease is associated with various adverse events. To understand the risk of thromboembolism, it is necessary to recognize when LVT is most likely to occur. We present a case of acute lymphocytic myocarditis in a young patient, where the LVT manifestation occurred within 48 hours after the beginning of the disease and was treated by thrombectomy. We have not found any reports of LVT formation earlier than in this case. Patients with acute myocarditis are younger, at a median age of 34 years, and the social impact of embolic complications is considerable. Echocardiography is effective in detecting LVT noninvasively in low- and high-risk patients. Patients with myocarditis can benefit from careful observation by echocardiography.