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Left Ventricular Thrombosis Refractory to Medical Therapy
Journal of the American College of Cardiology © 2010 by the American College of Cardiology Foundation Published by Elsevier Inc.
Vol. 56, No. 19, 2010 ISSN 0735-1097/$36.00 doi:10.1016/j.jacc.2009.05.084
IMAGES IN CARDIOLOGY
Left Ventricular Thrombosis Refractory to Medical Therapy Eric Russell, MD,* Victor Chien, MD,* Zain Khalpey, MD,†储 Marc Bonaca, MD,‡ Jayashri Aragam, MD,‡§ Miguel Haime, MD,†储 Michael Crittenden, MD†储 Boston, Massachusetts
From the *Boston University School of Medicine, Boston, Massachusetts; †Department of Surgery, Division of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; ‡Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts; §Department of Cardiology, Veteran’s Administration Boston Healthcare System, West Roxbury Division, Boston, Massachusetts; and the 储Surgical Service, Cardiac Surgery Section, Veteran’s Administration Boston Healthcare System, West Roxbury Division, Boston, Massachusetts. Manuscript received May 19, 2009; accepted May 31, 2009.
A
65-year-old man with a history of pulmonary emboli, atrial fibrillation, nonischemic dilated cardiomyopathy, and significant polysubstance abuse was admitted with dyspnea, new onset left-hand weakness, and a left-sided facial droop. An echocardiogram showed an estimated ejection fraction of 20% and an echogenic pedunculated mass in the left ventricle (LV) apex with minimal mobility consistent with an organized LV mural thrombus (A, Online Video 1). Low molecular weight heparin (LMWH) and warfarin were initiated; however, the patient developed a visual field deficit 9 days later. A second trial of anticoagulation therapy was attempted, and regular heparin was begun. An echocardiogram 3 days later showed a significant increase in the size and mobility of the thrombus (B, Online Videos 2 and 3). So as to avoid a potentially catastrophic embolic event, the patient underwent a thrombectomy via left ventriculotomy without complication (C).
Vol. 56, No. 19, 2010 ISSN 0735-1097/$36.00 doi:10.1016/j.jacc.2009.05.084
IMAGES IN CARDIOLOGY
Left Ventricular Thrombosis Refractory to Medical Therapy Eric Russell, MD,* Victor Chien, MD,* Zain Khalpey, MD,†储 Marc Bonaca, MD,‡ Jayashri Aragam, MD,‡§ Miguel Haime, MD,†储 Michael Crittenden, MD†储 Boston, Massachusetts
From the *Boston University School of Medicine, Boston, Massachusetts; †Department of Surgery, Division of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; ‡Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts; §Department of Cardiology, Veteran’s Administration Boston Healthcare System, West Roxbury Division, Boston, Massachusetts; and the 储Surgical Service, Cardiac Surgery Section, Veteran’s Administration Boston Healthcare System, West Roxbury Division, Boston, Massachusetts. Manuscript received May 19, 2009; accepted May 31, 2009.
A
65-year-old man with a history of pulmonary emboli, atrial fibrillation, nonischemic dilated cardiomyopathy, and significant polysubstance abuse was admitted with dyspnea, new onset left-hand weakness, and a left-sided facial droop. An echocardiogram showed an estimated ejection fraction of 20% and an echogenic pedunculated mass in the left ventricle (LV) apex with minimal mobility consistent with an organized LV mural thrombus (A, Online Video 1). Low molecular weight heparin (LMWH) and warfarin were initiated; however, the patient developed a visual field deficit 9 days later. A second trial of anticoagulation therapy was attempted, and regular heparin was begun. An echocardiogram 3 days later showed a significant increase in the size and mobility of the thrombus (B, Online Videos 2 and 3). So as to avoid a potentially catastrophic embolic event, the patient underwent a thrombectomy via left ventriculotomy without complication (C).