Successful surgical transmitral removal of left ventricular thrombus after acute anterior myocardial infarction without left ventriculotomy.

Left ventricular thrombus (LVT) is known as a life-threatening complication of acute myocardial infarction, in terms of sequential systemic embolization. When an LVT is found to be sufficiently large or mobile, not only anticoagulation therapy but also surgical thrombectomy should be administered immediately to prevent embolic events. Generally, since infarcted myocardium is comparatively fragile, ventriculotomy may result in anastomotic failure or further deterioration of LV function. We report herein a case of transmitral removal of LVT by which we successfully avoided ventriculotomy. A 50-year-old Japanese man was hospitalized due to ST-segment elevation myocardial infarction and emergency coronary angiography revealed total occlusion at the proximal left anterior descending artery. On hospital day 9, transthoracic echocardiography detected a massive LVT at the apex, protruding into the left ventricle. Considering the risk of embolization, urgent thrombectomy via a transmitral approach was performed. The LVT was easily removed through the mitral valve under endoscopic support, without any embolic events or postoperative complications. <Learning objective: Left ventricular thrombus following acute myocardial infarction may result in fatal embolization. Although surgical removal should be considered to prevent embolic events, some previous reports state that surgical approaches such as left ventriculotomy can lead to further cardiac dysfunction and ruptured sutures. Thus, transmitral approach may be useful for avoiding embolic events without left ventriculotomy and sequential complications.>.