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.
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.
Authors: Jonathan W Weinsaft; Han W Kim; Anna Lisa Crowley; Igor Klem; Chetan Shenoy; Lowie Van Assche; Rhoda Brosnan; Dipan J Shah; Eric J Velazquez; Michele Parker; Robert M Judd; Raymond J Kim Journal: JACC Cardiovasc Imaging Date: 2011-07
Authors: Roxy Senior; Harald Becher; Mark Monaghan; Luciano Agati; Jose Zamorano; Jean Louis Vanoverschelde; Petros Nihoyannopoulos Journal: Eur J Echocardiogr Date: 2009-03
Authors: E Loh; M S Sutton; C C Wun; J L Rouleau; G C Flaker; S S Gottlieb; G A Lamas; L A Moyé; S Z Goldhaber; M A Pfeffer Journal: N Engl J Med Date: 1997-01-23 Impact factor: 91.245